Provider Demographics
NPI:1225602410
Name:STORY AVE PHARMACY INC
Entity Type:Organization
Organization Name:STORY AVE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-822-2923
Mailing Address - Street 1:1903 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2705
Mailing Address - Country:US
Mailing Address - Phone:718-822-2923
Mailing Address - Fax:718-822-2924
Practice Address - Street 1:1903 STORY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2705
Practice Address - Country:US
Practice Address - Phone:718-822-2923
Practice Address - Fax:718-822-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038772OtherPHARMACY REGISTRATION