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General NPI Number Information
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NPI Number | 1679887772
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Entity Type | Organization
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Legal Business Name | GREENWICH PHARMACY LLC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 116 GREENWICH AVE
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City | GREENWICH
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State | CT
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Zip | 06830-5504
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Country | US
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Telephone | 203-661-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 11045 68TH AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-2936
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Country | US
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Telephone | 917-559-3632
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DMITRI DANAIROV
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Credential |
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Telephone | 203-661-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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