Provider Demographics
NPI:1477262533
Name:GRAND AVE CHEMISTS INC
Entity Type:Organization
Organization Name:GRAND AVE CHEMISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-374-7840
Mailing Address - Street 1:7201 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1560
Mailing Address - Country:US
Mailing Address - Phone:845-584-3317
Mailing Address - Fax:929-463-7139
Practice Address - Street 1:7201 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1560
Practice Address - Country:US
Practice Address - Phone:845-584-3317
Practice Address - Fax:929-463-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy