Provider Demographics
NPI:1346432473
Name:ELIYAHUS PHARMACY INC.
Entity Type:Organization
Organization Name:ELIYAHUS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R PH
Authorized Official - Prefix:
Authorized Official - First Name:ILIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MLABASATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-627-0485
Mailing Address - Street 1:573 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2003
Mailing Address - Country:US
Mailing Address - Phone:718-627-0485
Mailing Address - Fax:718-627-2757
Practice Address - Street 1:573 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2003
Practice Address - Country:US
Practice Address - Phone:718-627-0485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0241173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01903837Medicaid
4047170001Medicare NSC
NY01903837Medicaid