Provider Demographics
NPI:1639263494
Name:COKA PHARMACY
Entity Type:Organization
Organization Name:COKA PHARMACY
Other - Org Name:ROYAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:AVIVA
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-941-7722
Mailing Address - Street 1:2239 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3201
Mailing Address - Country:US
Mailing Address - Phone:718-941-7722
Mailing Address - Fax:718-941-0023
Practice Address - Street 1:2239 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3201
Practice Address - Country:US
Practice Address - Phone:718-941-7722
Practice Address - Fax:718-941-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0264723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5091050001Medicare NSC