Provider Demographics
NPI:1699068577
Name:PHARMAPACKS LLC
Entity type:Organization
Organization Name:PHARMAPACKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-767-7730
Mailing Address - Street 1:653 152ND ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1200
Mailing Address - Country:US
Mailing Address - Phone:718-767-7730
Mailing Address - Fax:718-767-7735
Practice Address - Street 1:653 152ND ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1200
Practice Address - Country:US
Practice Address - Phone:718-767-7730
Practice Address - Fax:718-767-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030641OtherNY STATE PHARMACY LICENSE