Provider Demographics
NPI:1386642973
Name:BAY RIDGE PEOPLE'S PHARMACY, INC
Entity Type:Organization
Organization Name:BAY RIDGE PEOPLE'S PHARMACY, INC
Other - Org Name:POWELLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-745-2660
Mailing Address - Street 1:7517 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3168
Mailing Address - Country:US
Mailing Address - Phone:718-745-2660
Mailing Address - Fax:718-680-7431
Practice Address - Street 1:7517 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3168
Practice Address - Country:US
Practice Address - Phone:718-745-2660
Practice Address - Fax:718-680-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026953332B00000X, 332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02570634Medicaid
NY3349986OtherNCPDP
NY3349986OtherNCPDP