Provider Demographics
NPI:1184022311
Name:CROWN HEIGHTS PHARMACY INC
Entity Type:Organization
Organization Name:CROWN HEIGHTS PHARMACY INC
Other - Org Name:APPLE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTLEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-467-6700
Mailing Address - Street 1:376 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4332
Mailing Address - Country:US
Mailing Address - Phone:718-467-6700
Mailing Address - Fax:718-467-2461
Practice Address - Street 1:376 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4332
Practice Address - Country:US
Practice Address - Phone:718-467-6700
Practice Address - Fax:718-467-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0204643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01175213Medicaid
NY01175213Medicaid