Provider Demographics
NPI:1497186910
Name:PHILLIPS PHARMACY INC
Entity Type:Organization
Organization Name:PHILLIPS PHARMACY INC
Other - Org Name:PHILLIPS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-843-8269
Mailing Address - Street 1:3921 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3207
Mailing Address - Country:US
Mailing Address - Phone:718-435-7790
Mailing Address - Fax:718-871-8020
Practice Address - Street 1:3921 9TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3207
Practice Address - Country:US
Practice Address - Phone:718-435-7790
Practice Address - Fax:718-871-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY032681333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145804OtherPK
NY03870537Medicaid
NY03870537Medicaid
NY7114950001Medicare NSC
2145804OtherPK
NY5810571OtherNCPDP