Provider Demographics
NPI:1457866337
Name:AHV PHARMACY, INC
Entity Type:Organization
Organization Name:AHV PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANISOV
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-740-1237
Mailing Address - Street 1:11150 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2542
Mailing Address - Country:US
Mailing Address - Phone:718-740-1237
Mailing Address - Fax:718-740-1085
Practice Address - Street 1:11150 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2542
Practice Address - Country:US
Practice Address - Phone:718-740-1237
Practice Address - Fax:718-740-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy