Provider Demographics
NPI:1629063367
Name:B.O.P PHARMACY INC.
Entity Type:Organization
Organization Name:B.O.P PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-539-8999
Mailing Address - Street 1:135-02 ROOSEVELT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5343
Mailing Address - Country:US
Mailing Address - Phone:718-359-6333
Mailing Address - Fax:718-359-5339
Practice Address - Street 1:135-02 ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5343
Practice Address - Country:US
Practice Address - Phone:718-359-6333
Practice Address - Fax:718-359-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0272903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2680308Medicaid
2064036OtherPK