Provider Demographics
NPI:1417059072
Name:GALUVI PHARMACY CORP
Entity Type:Organization
Organization Name:GALUVI PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELVIO
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:VIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-898-9833
Mailing Address - Street 1:11201 QUEENS BLVD
Mailing Address - Street 2:UNIT#14 D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5566
Mailing Address - Country:US
Mailing Address - Phone:718-544-9532
Mailing Address - Fax:
Practice Address - Street 1:4023 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2123
Practice Address - Country:US
Practice Address - Phone:718-898-9833
Practice Address - Fax:718-898-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0196293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01059787Medicaid