Provider Demographics
NPI:1114324050
Name:ADVANCED ASIAN PHARMACY LLC
Entity Type:Organization
Organization Name:ADVANCED ASIAN PHARMACY LLC
Other - Org Name:AA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MINRU
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-425-0965
Mailing Address - Street 1:849 57TH ST
Mailing Address - Street 2:FL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3797
Mailing Address - Country:US
Mailing Address - Phone:347-425-0965
Mailing Address - Fax:347-425-0966
Practice Address - Street 1:849 57TH ST STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3798
Practice Address - Country:US
Practice Address - Phone:347-425-0965
Practice Address - Fax:347-425-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03311423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149100OtherPK
7344060001Medicare NSC