Provider Demographics
NPI:1316997091
Name:ABO PHARMACY CORP
Entity type:Organization
Organization Name:ABO PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ARTEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-627-9410
Mailing Address - Street 1:8003 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3533
Mailing Address - Country:US
Mailing Address - Phone:718-872-5142
Mailing Address - Fax:718-872-5137
Practice Address - Street 1:8003 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3533
Practice Address - Country:US
Practice Address - Phone:718-872-5142
Practice Address - Fax:718-872-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2067741OtherPK
NY2749333Medicaid