Provider Demographics
NPI:1356627780
Name:ZOURA PHARMACY INC
Entity Type:Organization
Organization Name:ZOURA PHARMACY INC
Other - Org Name:EL AZAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-6445
Mailing Address - Street 1:464 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4011
Mailing Address - Country:US
Mailing Address - Phone:718-676-6445
Mailing Address - Fax:718-676-6446
Practice Address - Street 1:464 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4011
Practice Address - Country:US
Practice Address - Phone:718-676-6445
Practice Address - Fax:718-676-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0309743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03395255Medicaid
2132607OtherPK