Provider Demographics
NPI:1417432436
Name:FIVE BOROUGH PAHRAMACY LLC
Entity Type:Organization
Organization Name:FIVE BOROUGH PAHRAMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-983-9666
Mailing Address - Street 1:13149 234TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1311
Mailing Address - Country:US
Mailing Address - Phone:718-288-3488
Mailing Address - Fax:718-374-6796
Practice Address - Street 1:13149 234TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11422-1311
Practice Address - Country:US
Practice Address - Phone:718-288-3488
Practice Address - Fax:718-374-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies