Provider Demographics
NPI:1598869554
Name:ARCOLA PHARMACY CORP
Entity Type:Organization
Organization Name:ARCOLA PHARMACY CORP
Other - Org Name:ARCOLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHLAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-5838
Mailing Address - Street 1:6545 99TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4347
Mailing Address - Country:US
Mailing Address - Phone:718-275-5838
Mailing Address - Fax:718-275-5868
Practice Address - Street 1:6545 99TH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4347
Practice Address - Country:US
Practice Address - Phone:718-275-5838
Practice Address - Fax:718-275-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0232533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742103Medicaid
3320621OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3320621OtherNCPDP PROVIDER IDENTIFICATION NUMBER