Provider Demographics
NPI:1467597229
Name:FMRG PHARMACY INC
Entity Type:Organization
Organization Name:FMRG PHARMACY INC
Other - Org Name:KINGS CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELFAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-336-3355
Mailing Address - Street 1:433 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1718
Mailing Address - Country:US
Mailing Address - Phone:718-336-3355
Mailing Address - Fax:718-336-3355
Practice Address - Street 1:433 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1718
Practice Address - Country:US
Practice Address - Phone:718-336-3355
Practice Address - Fax:718-336-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0263113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496028Medicaid
3328235OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3328235OtherNCPDP PROVIDER IDENTIFICATION NUMBER