Provider Demographics
NPI:1407181811
Name:B&T MARLBORO PHARMACY, INC.
Entity Type:Organization
Organization Name:B&T MARLBORO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-373-4800
Mailing Address - Street 1:2845 86TH ST
Mailing Address - Street 2:FIRST FLOOR STORE FRONT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4634
Mailing Address - Country:US
Mailing Address - Phone:718-373-4800
Mailing Address - Fax:718-373-4848
Practice Address - Street 1:2845 86TH ST
Practice Address - Street 2:FIRST FLOOR STORE FRONT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4634
Practice Address - Country:US
Practice Address - Phone:718-373-4800
Practice Address - Fax:718-373-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B&T MARLBORO PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-03
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052435333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03185393Medicaid
NY6396370001Medicare NSC