Provider Demographics
NPI:1609257443
Name:ACHTAN INC
Entity Type:Organization
Organization Name:ACHTAN INC
Other - Org Name:BURKE AVENUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST /PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMERENTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKOKOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-326-6000
Mailing Address - Street 1:759 BURKE AVE
Mailing Address - Street 2:BURKE AVENUE PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6611
Mailing Address - Country:US
Mailing Address - Phone:347-326-6000
Mailing Address - Fax:347-326-6100
Practice Address - Street 1:759 BURKE AVE
Practice Address - Street 2:BURKE AVENUE PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6611
Practice Address - Country:US
Practice Address - Phone:347-326-6000
Practice Address - Fax:347-326-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI046376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7428670001Medicare NSC