Provider Demographics
NPI:1538669833
Name:BORO PARK PHARMACY CORP.
Entity Type:Organization
Organization Name:BORO PARK PHARMACY CORP.
Other - Org Name:BORO PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AKIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-982-8505
Mailing Address - Street 1:5600 NEW UTRECHT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4631
Mailing Address - Country:US
Mailing Address - Phone:718-480-0700
Mailing Address - Fax:718-480-7801
Practice Address - Street 1:5600 NEW UTRECHT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4631
Practice Address - Country:US
Practice Address - Phone:718-480-0700
Practice Address - Fax:718-480-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0351953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175771OtherPK