Provider Demographics
NPI:1043360506
Name:WOODHAVEN BLVD. PHARMACY
Entity Type:Organization
Organization Name:WOODHAVEN BLVD. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-478-4600
Mailing Address - Street 1:6222 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2745
Mailing Address - Country:US
Mailing Address - Phone:718-478-4600
Mailing Address - Fax:718-478-7731
Practice Address - Street 1:6222 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2745
Practice Address - Country:US
Practice Address - Phone:718-478-4600
Practice Address - Fax:718-478-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021789OtherPHARMACY