Provider Demographics
NPI:1275697823
Name:MIDDLE VILLAGE PHARMACY
Entity Type:Organization
Organization Name:MIDDLE VILLAGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTINE
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-326-3072
Mailing Address - Street 1:7404 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2637
Mailing Address - Country:US
Mailing Address - Phone:718-326-3702
Mailing Address - Fax:718-326-3059
Practice Address - Street 1:7404 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2637
Practice Address - Country:US
Practice Address - Phone:718-326-3702
Practice Address - Fax:718-326-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042918-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty