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General NPI Number Information
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NPI Number | 1770858680
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Entity Type | Organization
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Legal Business Name | TRIBORO PHARMACY
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 3720 DITMARS BLVD
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City | ASTORIA
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State | NY
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Zip | 11105-1841
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Country | US
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Telephone | 718-777-7033
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Fax | 718-777-7038
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Provider Business Mailing Address
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Address Line | 3720 DITMARS BLVD
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City | ASTORIA
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State | NY
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Zip | 11105-1841
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Country | US
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Telephone | 718-777-7033
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Fax | 718-777-7038
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Authorized Official
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Title or Position | OWNER/SUPERVISING PHARMACIST
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Name | JOHN ATHANASATOS
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Credential | RPH
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Telephone | 917-865-7754
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031263
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License Number State | NY
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