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General NPI Number Information
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NPI Number | 1821003476
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Entity Type | Organization
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Legal Business Name | 18TH AVENUE DRUG STORE INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 8110 18TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-2201
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Country | US
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Telephone | 718-232-5566
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Fax | 718-232-5255
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Provider Business Mailing Address
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Address Line | 8110 18TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11214-2201
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Country | US
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Telephone | 718-232-5566
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Fax | 718-232-5255
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Authorized Official
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Title or Position | OWNER/SEC
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Name | MARAT BLUSTIN
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Credential |
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Telephone | 917-922-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027708
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License Number State | NY
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