Provider Demographics
NPI:1164567061
Name:SKY PHARMACY
Entity Type:Organization
Organization Name:SKY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-621-0204
Mailing Address - Street 1:7114 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6016
Mailing Address - Country:US
Mailing Address - Phone:718-621-0204
Mailing Address - Fax:718-621-1443
Practice Address - Street 1:7114 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6016
Practice Address - Country:US
Practice Address - Phone:718-621-0204
Practice Address - Fax:718-621-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0268823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02614340Medicaid
NY5270080001Medicare NSC