Provider Demographics
NPI:1477934891
Name:FEDCO CHEMIST PHARMACY CORP
Entity Type:Organization
Organization Name:FEDCO CHEMIST PHARMACY CORP
Other - Org Name:FEDCO CHEMIST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLOKANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-294-0501
Mailing Address - Street 1:512 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3253
Mailing Address - Country:US
Mailing Address - Phone:914-294-0501
Mailing Address - Fax:914-294-0504
Practice Address - Street 1:512 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3253
Practice Address - Country:US
Practice Address - Phone:914-294-0501
Practice Address - Fax:914-294-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy