Provider Demographics
NPI:1699154732
Name:ELMWAY II PHARMACY INC
Entity type:Organization
Organization Name:ELMWAY II PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-699-1882
Mailing Address - Street 1:8607 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3922
Mailing Address - Country:US
Mailing Address - Phone:718-699-1882
Mailing Address - Fax:
Practice Address - Street 1:8607 51ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3922
Practice Address - Country:US
Practice Address - Phone:718-699-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0033562OtherNYS BOARD OF PHARMACY