Provider Demographics
NPI:1528362811
Name:ABC PHARMACY V CORP.
Entity Type:Organization
Organization Name:ABC PHARMACY V CORP.
Other - Org Name:ABC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOK DOON JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-680-6278
Mailing Address - Street 1:17 E BROADWAY STORE #105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-6994
Mailing Address - Country:US
Mailing Address - Phone:212-965-8882
Mailing Address - Fax:212-965-8278
Practice Address - Street 1:17 E BROADWAY STORE #105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6994
Practice Address - Country:US
Practice Address - Phone:212-965-8882
Practice Address - Fax:212-965-8278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030509333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5801938OtherNCDBP
NY5801938OtherNCDBP