Provider Demographics
NPI:1740767391
Name:FULTON 1ST PHARMACY, INC
Entity Type:Organization
Organization Name:FULTON 1ST PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELRASHIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-922-8282
Mailing Address - Street 1:1185 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1810
Mailing Address - Country:US
Mailing Address - Phone:718-484-9100
Mailing Address - Fax:718-484-9109
Practice Address - Street 1:1185 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1810
Practice Address - Country:US
Practice Address - Phone:718-484-9100
Practice Address - Fax:718-484-9109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULTON 1ST PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04061441Medicaid