Provider Demographics
NPI:1588697692
Name:GAMER PHARMACY INC
Entity type:Organization
Organization Name:GAMER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSKOBOYNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-837-0600
Mailing Address - Street 1:6725 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4735
Mailing Address - Country:US
Mailing Address - Phone:718-837-0600
Mailing Address - Fax:718-837-0140
Practice Address - Street 1:6725 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4735
Practice Address - Country:US
Practice Address - Phone:718-837-0600
Practice Address - Fax:718-837-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0251193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02183246Medicaid
2063429OtherPK
NY02183246Medicaid