Provider Demographics
NPI:1093069114
Name:HOMECREST V&I PHARMACY INC.
Entity Type:Organization
Organization Name:HOMECREST V&I PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSTYLNIK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:718-753-1296
Mailing Address - Street 1:1826 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4511
Mailing Address - Country:US
Mailing Address - Phone:718-872-6655
Mailing Address - Fax:
Practice Address - Street 1:1826 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4511
Practice Address - Country:US
Practice Address - Phone:718-872-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6730690001Medicare NSC