Provider Demographics
NPI:1275043200
Name:GVM PHARMACY INC
Entity Type:Organization
Organization Name:GVM PHARMACY INC
Other - Org Name:STATEN ISLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-489-4994
Mailing Address - Street 1:203 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1415
Mailing Address - Country:US
Mailing Address - Phone:718-489-4994
Mailing Address - Fax:718-489-4996
Practice Address - Street 1:203 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1415
Practice Address - Country:US
Practice Address - Phone:718-489-4994
Practice Address - Fax:718-489-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy