Provider Demographics
NPI:1073658993
Name:N & B PHARMACY INC
Entity Type:Organization
Organization Name:N & B PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZYLOV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-487-8100
Mailing Address - Street 1:11829A METROPOLITAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:718-487-8100
Mailing Address - Fax:718-487-8300
Practice Address - Street 1:11829A METROPOLITAN AVENUE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:718-487-8100
Practice Address - Fax:718-487-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025513333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02350232Medicaid