Provider Demographics
NPI:1225437650
Name:37TH AVE PHARMACY INC
Entity Type:Organization
Organization Name:37TH AVE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYORINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718424-868-4036
Mailing Address - Street 1:9507 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8024
Mailing Address - Country:US
Mailing Address - Phone:718-424-8684
Mailing Address - Fax:
Practice Address - Street 1:9507 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8024
Practice Address - Country:US
Practice Address - Phone:718-424-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059015282NC0060X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3336C0004XSuppliersPharmacyCompounding Pharmacy