Provider Demographics
NPI:1659367415
Name:ALDAV PHARMACY, INC
Entity Type:Organization
Organization Name:ALDAV PHARMACY, INC
Other - Org Name:ALDAV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-724-2245
Mailing Address - Street 1:749 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7813
Mailing Address - Country:US
Mailing Address - Phone:718-724-2245
Mailing Address - Fax:718-724-0975
Practice Address - Street 1:749 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7813
Practice Address - Country:US
Practice Address - Phone:718-724-2245
Practice Address - Fax:718-724-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0254663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02318050Medicaid
2064343OtherPK
NY02318050Medicaid