=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841732237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK PHARMACY NETWORK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 444 MERRICK RD STE LL5 LL5
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-531-5000
-----------------------------------------------------
Fax | 877-531-5006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 MERRICK RD SUITE LL5
-----------------------------------------------------
City | LYNBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11563-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-531-5000
-----------------------------------------------------
Fax | 877-531-5006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COEO
-----------------------------------------------------
Name | JEFFREY FRIEDMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-531-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 035055
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------