Provider Demographics
NPI:1265443824
Name:FARMACON ENTERPRISES LTD
Entity Type:Organization
Organization Name:FARMACON ENTERPRISES LTD
Other - Org Name:FARMACON ENT LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRIADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-238-1090
Mailing Address - Street 1:8007 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4003
Mailing Address - Country:US
Mailing Address - Phone:718-238-1090
Mailing Address - Fax:718-748-9275
Practice Address - Street 1:8007 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4003
Practice Address - Country:US
Practice Address - Phone:718-238-1090
Practice Address - Fax:718-748-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0156273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3362679OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY00268539Medicaid
1254920001Medicare NSC