Provider Demographics
NPI:1659756872
Name:COMMCARE PHARMACY - NYC, LLC
Entity Type:Organization
Organization Name:COMMCARE PHARMACY - NYC, LLC
Other - Org Name:TOTAL CARE RX WORLD'S FAIR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ISAAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-332-6178
Mailing Address - Street 1:13034 BALLANTYNE CORPORATE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1498
Mailing Address - Country:US
Mailing Address - Phone:954-332-6178
Mailing Address - Fax:
Practice Address - Street 1:5737 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5332
Practice Address - Country:US
Practice Address - Phone:718-358-1300
Practice Address - Fax:718-764-6491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NS3 HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy