Provider Demographics
NPI:1649754904
Name:CITI EXPRESS PHARMACY AND MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:CITI EXPRESS PHARMACY AND MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLYJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-355-8800
Mailing Address - Street 1:4217 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3011
Mailing Address - Country:US
Mailing Address - Phone:718-355-8800
Mailing Address - Fax:646-588-0462
Practice Address - Street 1:4217 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3011
Practice Address - Country:US
Practice Address - Phone:718-355-8800
Practice Address - Fax:646-588-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760639108Medicaid