Provider Demographics
NPI:1891961918
Name:SEA BREEZE PHARMACY & MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:SEA BREEZE PHARMACY & MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-646-0660
Mailing Address - Street 1:1129 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5903
Mailing Address - Country:US
Mailing Address - Phone:718-646-0660
Mailing Address - Fax:347-587-6214
Practice Address - Street 1:1129 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5903
Practice Address - Country:US
Practice Address - Phone:718-646-0660
Practice Address - Fax:347-587-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6127780001Medicare NSC