Provider Demographics
NPI:1386788743
Name:AVALON CHEMISTS INC
Entity type:Organization
Organization Name:AVALON CHEMISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-260-3131
Mailing Address - Street 1:7 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8674
Mailing Address - Country:US
Mailing Address - Phone:212-260-3131
Mailing Address - Fax:212-260-3155
Practice Address - Street 1:7 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8674
Practice Address - Country:US
Practice Address - Phone:212-260-3131
Practice Address - Fax:212-260-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0281073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02814717Medicaid
NY5897100001Medicare NSC