Provider Demographics
NPI:1710975198
Name:ALISONS PHARMACY INC
Entity Type:Organization
Organization Name:ALISONS PHARMACY INC
Other - Org Name:ALISONS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:XIN
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-227-7065
Mailing Address - Street 1:12 BOWERY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5182
Mailing Address - Country:US
Mailing Address - Phone:212-227-7065
Mailing Address - Fax:212-227-0745
Practice Address - Street 1:12 BOWERY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5182
Practice Address - Country:US
Practice Address - Phone:212-227-7065
Practice Address - Fax:212-227-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0222713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2060114OtherPK
NY1528505Medicaid
NY1528505Medicaid