Provider Demographics
NPI:1043449630
Name:FAMILY CHOICE PHARMACY CORP
Entity Type:Organization
Organization Name:FAMILY CHOICE PHARMACY CORP
Other - Org Name:FAMILY CHOICE PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAN MAN ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-925-6088
Mailing Address - Street 1:13-17 ELIZABETH ST LOWER LEVEL UNIT #10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-925-6088
Mailing Address - Fax:212-925-5088
Practice Address - Street 1:13-17 ELIZABETH ST LOWER LEVEL UNIT #10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-925-6088
Practice Address - Fax:212-925-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0296763336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122042OtherPK
NY3153308Medicaid
NY3153308Medicaid