Provider Demographics
NPI:1245378769
Name:PEPCO PHARMACY
Entity Type:Organization
Organization Name:PEPCO PHARMACY
Other - Org Name:KARSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-338-0709
Mailing Address - Street 1:2304 NOSTRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:718-338-0709
Mailing Address - Fax:718-252-2284
Practice Address - Street 1:2304 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3840
Practice Address - Country:US
Practice Address - Phone:718-338-0709
Practice Address - Fax:718-252-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19213333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00975833Medicaid
NY00975833Medicaid