Provider Demographics
NPI:1275003261
Name:APP PHARMACY INC
Entity Type:Organization
Organization Name:APP PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PULATOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-522-0858
Mailing Address - Street 1:5809 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3437
Mailing Address - Country:US
Mailing Address - Phone:929-522-0858
Mailing Address - Fax:
Practice Address - Street 1:5809 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3437
Practice Address - Country:US
Practice Address - Phone:929-522-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04671147Medicaid