Provider Demographics
NPI:1659611820
Name:NEW WILLIAMSBURG PHARMACY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NEW WILLIAMSBURG PHARMACY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-875-1505
Mailing Address - Street 1:517 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1631
Mailing Address - Country:US
Mailing Address - Phone:718-875-1505
Mailing Address - Fax:718-875-1507
Practice Address - Street 1:517 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1631
Practice Address - Country:US
Practice Address - Phone:718-875-1505
Practice Address - Fax:718-875-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy