Provider Demographics
NPI:1528482213
Name:PARK CHEMISTS LLC
Entity type:Organization
Organization Name:PARK CHEMISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-393-5555
Mailing Address - Street 1:164 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2696
Mailing Address - Country:US
Mailing Address - Phone:718-393-5555
Mailing Address - Fax:718-638-1112
Practice Address - Street 1:164 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2696
Practice Address - Country:US
Practice Address - Phone:718-393-5555
Practice Address - Fax:718-638-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7148750001Medicare NSC