Provider Demographics
NPI:1376854323
Name:NYC WHOLESALE INC
Entity Type:Organization
Organization Name:NYC WHOLESALE INC
Other - Org Name:MOON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-401-2773
Mailing Address - Street 1:63-52 WOODHAVEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-739-0300
Mailing Address - Fax:718-739-0301
Practice Address - Street 1:63-52 WOODHAVEN BLVD.
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-739-0300
Practice Address - Fax:718-739-0301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYC WHOLESALE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-24
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17-0300553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy