Provider Demographics
NPI:1306170063
Name:HEIGHTS APOTHECARY INC
Entity type:Organization
Organization Name:HEIGHTS APOTHECARY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AWATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYROUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-522-2588
Mailing Address - Street 1:79 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5503
Mailing Address - Country:US
Mailing Address - Phone:718-522-2588
Mailing Address - Fax:718-522-2388
Practice Address - Street 1:79 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5503
Practice Address - Country:US
Practice Address - Phone:718-522-2588
Practice Address - Fax:718-522-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122227OtherPK
NY3160890Medicaid