Provider Demographics
NPI:1760490007
Name:AVZ CORP
Entity Type:Organization
Organization Name:AVZ CORP
Other - Org Name:AV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-271-1262
Mailing Address - Street 1:9461 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2830
Mailing Address - Country:US
Mailing Address - Phone:718-271-1262
Mailing Address - Fax:718-271-3157
Practice Address - Street 1:9461 CORONA AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2830
Practice Address - Country:US
Practice Address - Phone:718-271-1262
Practice Address - Fax:718-271-3157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0274293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066187OtherPK
NY02700567Medicaid
5518710001Medicare NSC