Provider Demographics
NPI:1619195898
Name:WAKEFIELD PHARMACY INC.
Entity Type:Organization
Organization Name:WAKEFIELD PHARMACY INC.
Other - Org Name:QUEENS WAKEFIELD PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH-BS-MS-PHARMD
Authorized Official - Phone:718-843-3900
Mailing Address - Street 1:13525 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3601
Mailing Address - Country:US
Mailing Address - Phone:718-843-3900
Mailing Address - Fax:718-843-6044
Practice Address - Street 1:13525 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3601
Practice Address - Country:US
Practice Address - Phone:718-843-3900
Practice Address - Fax:718-843-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3375816OtherNAPB NUMBER
NY017693OtherSTORE STATE LICENSE NO.
NY017693OtherSTORE STATE LICENSE NO.