Provider Demographics
NPI:1326053943
Name:CROSS BAY CHEMISTS CORP
Entity Type:Organization
Organization Name:CROSS BAY CHEMISTS CORP
Other - Org Name:CROSS BAY CHEMISTS CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-659-9500
Mailing Address - Street 1:157-02 CROSS BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-659-9500
Mailing Address - Fax:718-659-9100
Practice Address - Street 1:157-02 CROSS BAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-659-9500
Practice Address - Fax:718-659-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0268133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02580023Medicaid
2062862OtherPK
5208270001Medicare NSC