Provider Demographics
NPI:1376896399
Name:IDEAL CARE PHARMACY INC
Entity Type:Organization
Organization Name:IDEAL CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-382-1990
Mailing Address - Street 1:811 AVE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223
Mailing Address - Country:US
Mailing Address - Phone:718-382-1990
Mailing Address - Fax:718-382-1991
Practice Address - Street 1:811 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4176
Practice Address - Country:US
Practice Address - Phone:718-382-1990
Practice Address - Fax:718-382-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare UPIN