Provider Demographics
NPI:1437400223
Name:WOODHAVEN PHARMACY INC.
Entity Type:Organization
Organization Name:WOODHAVEN PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALACHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-478-4600
Mailing Address - Street 1:6220 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2745
Mailing Address - Country:US
Mailing Address - Phone:718-478-4600
Mailing Address - Fax:718-478-7731
Practice Address - Street 1:6220 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2745
Practice Address - Country:US
Practice Address - Phone:718-478-4600
Practice Address - Fax:718-478-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy