Provider Demographics
NPI:1376052522
Name:HOWARD BEACH PHARMACY LLC
Entity Type:Organization
Organization Name:HOWARD BEACH PHARMACY LLC
Other - Org Name:ORGANYC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRIYELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-487-3930
Mailing Address - Street 1:13340 79TH ST
Mailing Address - Street 2:STORE I
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1009
Mailing Address - Country:US
Mailing Address - Phone:718-487-3930
Mailing Address - Fax:718-487-3952
Practice Address - Street 1:13340 79TH ST
Practice Address - Street 2:STORE I
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1009
Practice Address - Country:US
Practice Address - Phone:718-487-3930
Practice Address - Fax:718-487-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy