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General NPI Number Information
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NPI Number | 1962742924
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Entity Type | Organization
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Legal Business Name | ZYNWA5 INC
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Dates
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Enumeration Date | 02/27/2013
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 5311 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-4238
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Country | US
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Telephone | 718-255-6355
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Fax | 718-255-6353
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Provider Business Mailing Address
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Address Line | 5311 ROOSEVELT AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-4238
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Country | US
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Telephone | 718-255-6355
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Fax | 718-255-6353
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Authorized Official
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Title or Position | PRESIDENT
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Name | WIAME DOUHGRI
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Credential |
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Telephone | 718-255-6355
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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 | 031764
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License Number State | NY
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