Provider Demographics
NPI:1619487337
Name:PEARL PHARMACY CORP
Entity Type:Organization
Organization Name:PEARL PHARMACY CORP
Other - Org Name:FRANCONIA PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAKHTIYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-539-2144
Mailing Address - Street 1:50 FULTON AVE # STORE1
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3686
Mailing Address - Country:US
Mailing Address - Phone:516-539-2144
Mailing Address - Fax:516-539-2141
Practice Address - Street 1:50 FULTON AVE # STORE1
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3686
Practice Address - Country:US
Practice Address - Phone:516-539-2144
Practice Address - Fax:516-539-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-08
Last Update Date:2017-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy