Provider Demographics
NPI:1629173372
Name:CMD ENTERPRISES LLC
Entity Type:Organization
Organization Name:CMD ENTERPRISES LLC
Other - Org Name:BUY-RITE PHARMACY III
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGEMENT MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIMA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-353-5737
Mailing Address - Street 1:136-10/12 38TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-353-5737
Mailing Address - Fax:718-353-6197
Practice Address - Street 1:136-10/12 38TH AVENUE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-353-5737
Practice Address - Fax:718-353-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621465Medicaid
NY5351780001Medicare ID - Type Unspecified
NY5351780001Medicare NSC