Provider Demographics
NPI:1659649192
Name:HEALTH CARE PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTH CARE PHARMACY LLC
Other - Org Name:HEALTH CARE PHARMACY LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-6731
Mailing Address - Street 1:1437 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2330
Mailing Address - Country:US
Mailing Address - Phone:716-676-6731
Mailing Address - Fax:718-676-6733
Practice Address - Street 1:1437 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2330
Practice Address - Country:US
Practice Address - Phone:716-676-6731
Practice Address - Fax:718-676-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0309933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133040OtherPK
NY03486862Medicaid