Provider Demographics
NPI:1659483667
Name:B&B PHARMACY INC
Entity Type:Organization
Organization Name:B&B PHARMACY INC
Other - Org Name:B AND B PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVER
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:718-533-6623
Mailing Address - Street 1:7908 37TH AVE
Mailing Address - Street 2:80-09/11 37TH AVE
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6748
Mailing Address - Country:US
Mailing Address - Phone:718-533-6623
Mailing Address - Fax:718-533-6623
Practice Address - Street 1:7908 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6748
Practice Address - Country:US
Practice Address - Phone:718-533-6623
Practice Address - Fax:718-533-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0244713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02002986Medicaid
2059063OtherPK
NY02002986Medicaid