Provider Demographics
NPI:1689859217
Name:GN PHARMACY LLC
Entity Type:Organization
Organization Name:GN PHARMACY LLC
Other - Org Name:GN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:516-304-5380
Mailing Address - Street 1:800 NORTHERN BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 NORTHERN BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5314
Practice Address - Country:US
Practice Address - Phone:516-304-5380
Practice Address - Fax:516-213-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287033336C0003X
3336C0004X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3357173OtherOTHER ID NUMBER
NY6100180001Medicare NSC