Provider Demographics
NPI:1558529784
Name:MB PHARMACY LLC
Entity Type:Organization
Organization Name:MB PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCHASOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-268-1900
Mailing Address - Street 1:11457 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6554
Mailing Address - Country:US
Mailing Address - Phone:718-268-1900
Mailing Address - Fax:718-260-0013
Practice Address - Street 1:11457 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6554
Practice Address - Country:US
Practice Address - Phone:718-268-1900
Practice Address - Fax:718-268-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6116040001Medicare NSC