Provider Demographics
NPI:1235599093
Name:QUEST PHARMACY CORP.
Entity Type:Organization
Organization Name:QUEST PHARMACY CORP.
Other - Org Name:SURF AVENUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-266-6111
Mailing Address - Street 1:2115 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2108
Mailing Address - Country:US
Mailing Address - Phone:718-266-6111
Mailing Address - Fax:718-266-2000
Practice Address - Street 1:2115 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2108
Practice Address - Country:US
Practice Address - Phone:718-266-6111
Practice Address - Fax:718-266-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy