Provider Demographics
NPI:1295832137
Name:BROWNSVILLE COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:BROWNSVILLE COMMUNITY PHARMACY INC
Other - Org Name:BROWNSVILLE COMMUNITY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELDHO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM, RPH
Authorized Official - Phone:718-345-3399
Mailing Address - Street 1:592 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5539
Mailing Address - Country:US
Mailing Address - Phone:718-345-3399
Mailing Address - Fax:718-345-2286
Practice Address - Street 1:592 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5539
Practice Address - Country:US
Practice Address - Phone:718-345-3399
Practice Address - Fax:718-345-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0253123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292111Medicaid
2064262OtherPK
5305830001Medicare NSC