Provider Demographics
NPI:1619565728
Name:LAURELTON PHARMACY INC
Entity Type:Organization
Organization Name:LAURELTON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-387-9003
Mailing Address - Street 1:22401 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2704
Mailing Address - Country:US
Mailing Address - Phone:917-650-4009
Mailing Address - Fax:
Practice Address - Street 1:22401 141ST AVE
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2704
Practice Address - Country:US
Practice Address - Phone:917-387-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy