Provider Demographics
NPI:1669005971
Name:NY NORTHERN PHARMACY2 INC
Entity Type:Organization
Organization Name:NY NORTHERN PHARMACY2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOSUNG
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-279-4888
Mailing Address - Street 1:19206 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2955
Mailing Address - Country:US
Mailing Address - Phone:718-279-4888
Mailing Address - Fax:718-279-8881
Practice Address - Street 1:19206 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2955
Practice Address - Country:US
Practice Address - Phone:718-279-4888
Practice Address - Fax:718-279-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy