Provider Demographics
NPI:1699824524
Name:GSV PHARMACY INC
Entity Type:Organization
Organization Name:GSV PHARMACY INC
Other - Org Name:LANE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-435-1118
Mailing Address - Street 1:4623 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2631
Mailing Address - Country:US
Mailing Address - Phone:718-435-1118
Mailing Address - Fax:
Practice Address - Street 1:4623 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2631
Practice Address - Country:US
Practice Address - Phone:718-435-1118
Practice Address - Fax:718-435-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 3336S0011X
NY028914332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028914OtherSTATE LICENSE