1699059436 NPI number — FAMILY PHARMACY SOLUTIONS INC

Table of content: (NPI 1699059436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699059436 NPI number — FAMILY PHARMACY SOLUTIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHARMACY SOLUTIONS 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:
Provider Other Organization Name Type Code:
6
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:
1699059436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2066 FLATBUSH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-4314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-377-4900
Provider Business Mailing Address Fax Number:
718-253-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 E 142ND ST
Provider Second Line Business Practice Location Address:
1ST FL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10454-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-764-1002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DIAMOND
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-806-4067

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  030818 , 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: 5803590 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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