Provider Demographics
NPI:1477051571
Name:WOODHULL PRESCRIPTION CENTER INC.
Entity Type:Organization
Organization Name:WOODHULL PRESCRIPTION CENTER INC.
Other - Org Name:MEDLY SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-388-4588
Mailing Address - Street 1:755 FLUSHING AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4419
Mailing Address - Country:US
Mailing Address - Phone:718-599-1309
Mailing Address - Fax:718-599-1374
Practice Address - Street 1:755 FLUSHING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4419
Practice Address - Country:US
Practice Address - Phone:718-599-1309
Practice Address - Fax:718-599-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0254693336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02291972Medicaid