Provider Demographics
NPI:1225125420
Name:MIEL PHARMACY CORP
Entity Type:Organization
Organization Name:MIEL PHARMACY CORP
Other - Org Name:FAMILY DRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHCHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-759-9500
Mailing Address - Street 1:8617 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5201
Mailing Address - Country:US
Mailing Address - Phone:718-759-9500
Mailing Address - Fax:718-759-1411
Practice Address - Street 1:8617 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5201
Practice Address - Country:US
Practice Address - Phone:718-759-9500
Practice Address - Fax:718-759-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0259843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02393135Medicaid
2059858OtherPK
NY02393135Medicaid