Provider Demographics
NPI:1144361684
Name:AVENUE A PHARMACY, INC
Entity type:Organization
Organization Name:AVENUE A PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-260-4878
Mailing Address - Street 1:41 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7628
Mailing Address - Country:US
Mailing Address - Phone:212-260-4878
Mailing Address - Fax:212-260-4941
Practice Address - Street 1:41 AVENUE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009
Practice Address - Country:US
Practice Address - Phone:212-260-4878
Practice Address - Fax:212-260-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994310Medicaid
NY5086430001Medicare NSC