Provider Demographics
NPI:1225185432
Name:ASICS PHARMACY INC
Entity Type:Organization
Organization Name:ASICS PHARMACY INC
Other - Org Name:ANDREWS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-248-7177
Mailing Address - Street 1:370 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:370 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2106
Practice Address - Country:US
Practice Address - Phone:516-248-7177
Practice Address - Fax:516-248-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019438333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3397519OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY01359035Medicaid
3397519OtherOTHER ID NUMBER-COMMERCIAL NUMBER