Provider Demographics
NPI:1154861458
Name:ROOSEVELT AID PHARMACY INC
Entity Type:Organization
Organization Name:ROOSEVELT AID PHARMACY INC
Other - Org Name:HUDSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KATANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-448-6965
Mailing Address - Street 1:6508 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2928
Mailing Address - Country:US
Mailing Address - Phone:347-448-6965
Mailing Address - Fax:347-448-6826
Practice Address - Street 1:6508 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2928
Practice Address - Country:US
Practice Address - Phone:347-448-6965
Practice Address - Fax:347-448-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033425333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167798OtherPK