Provider Demographics
NPI:1104064666
Name:MEDICINE PLAZA INC
Entity type:Organization
Organization Name:MEDICINE PLAZA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-627-0800
Mailing Address - Street 1:1312 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1904
Mailing Address - Country:US
Mailing Address - Phone:718-627-0800
Mailing Address - Fax:718-627-5400
Practice Address - Street 1:1312 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1904
Practice Address - Country:US
Practice Address - Phone:718-627-0800
Practice Address - Fax:718-627-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
043187-13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6250230001Medicare NSC