Provider Demographics
NPI:1962435610
Name:WALLSTREET CHEMISTS INC.
Entity type:Organization
Organization Name:WALLSTREET CHEMISTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:FIAZ
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-699-7700
Mailing Address - Street 1:9721 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3540
Mailing Address - Country:US
Mailing Address - Phone:718-699-7700
Mailing Address - Fax:718-699-7222
Practice Address - Street 1:9721 57TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3540
Practice Address - Country:US
Practice Address - Phone:718-699-7700
Practice Address - Fax:718-699-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0278353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02728710Medicaid
NY5748980001Medicare NSC