Provider Demographics
NPI:1144590860
Name:AHAVA GROUP II
Entity Type:Organization
Organization Name:AHAVA GROUP II
Other - Org Name:PENINSULA PHARMACY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIN
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-1000
Mailing Address - Street 1:5350 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6703
Mailing Address - Country:US
Mailing Address - Phone:718-629-1000
Mailing Address - Fax:
Practice Address - Street 1:5115 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1042
Practice Address - Country:US
Practice Address - Phone:718-629-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy