Provider Demographics
NPI:1427061142
Name:E.L. PHARMACY CORP.
Entity type:Organization
Organization Name:E.L. PHARMACY CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALOUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-339-3400
Mailing Address - Street 1:259 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5939
Mailing Address - Country:US
Mailing Address - Phone:718-339-3400
Mailing Address - Fax:718-339-5239
Practice Address - Street 1:259 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5939
Practice Address - Country:US
Practice Address - Phone:718-339-3400
Practice Address - Fax:718-339-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0273153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683856Medicaid
NY02683856Medicaid