Provider Demographics
NPI:1992977094
Name:QUEENS CROSSING PHARMACY,INC.
Entity type:Organization
Organization Name:QUEENS CROSSING PHARMACY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-460-1180
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4233
Mailing Address - Country:US
Mailing Address - Phone:718-460-1180
Mailing Address - Fax:718-460-1182
Practice Address - Street 1:13620 38TH AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4233
Practice Address - Country:US
Practice Address - Phone:718-460-1180
Practice Address - Fax:718-460-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028730333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02974358Medicaid
NY02974358Medicaid