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General NPI Number Information
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NPI Number | 1891784948
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Entity Type | Organization
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Legal Business Name | YMGA PHARMACY SERVICES, CORP
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 8510 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-4610
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Country | US
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Telephone | 718-680-9855
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Fax | 718-680-9856
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Provider Business Mailing Address
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Address Line | 8510 3RD AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-4610
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Country | US
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Telephone | 718-680-9855
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Fax | 718-680-9856
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTON FALLAH
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Credential | RPH
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Telephone | 718-680-9855
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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 | 025286
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License Number State | NY
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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 | 025286
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License Number State | NY
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