Provider Demographics
NPI:1316174659
Name:74-17 101 AVE PHARMACY INC.
Entity type:Organization
Organization Name:74-17 101 AVE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-296-1023
Mailing Address - Street 1:7417 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1026
Mailing Address - Country:US
Mailing Address - Phone:718-296-1023
Mailing Address - Fax:718-296-1023
Practice Address - Street 1:7417 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1026
Practice Address - Country:US
Practice Address - Phone:718-296-1023
Practice Address - Fax:718-296-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTF-26718203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy