Provider Demographics
NPI:1114414083
Name:PARK CHEMISTS 4 AV LLC
Entity Type:Organization
Organization Name:PARK CHEMISTS 4 AV LLC
Other - Org Name:PARK CHEMISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-881-2970
Mailing Address - Street 1:500 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4881
Mailing Address - Country:US
Mailing Address - Phone:718-567-4555
Mailing Address - Fax:
Practice Address - Street 1:500 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4881
Practice Address - Country:US
Practice Address - Phone:718-567-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy