1962773051 NPI number — YMD PHARMACY, INC.

Table of content: (NPI 1962773051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962773051 NPI number — YMD PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YMD PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YMD PHARMACY, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962773051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 UTICA AVE
Provider Second Line Business Mailing Address:
STORE # 3
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11203-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-221-6814
Provider Business Mailing Address Fax Number:
718-221-6815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 UTICA AVE
Provider Second Line Business Practice Location Address:
STORE # 3
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-221-6814
Provider Business Practice Location Address Fax Number:
718-221-6815
Provider Enumeration Date:
01/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DALIA
Authorized Official First Name:
MO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER - OWNER
Authorized Official Telephone Number:
718-221-6814

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 031062 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5804174 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03432611 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962773051 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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