Provider Demographics
NPI:1770241689
Name:AMK PHARMACY LLC
Entity Type:Organization
Organization Name:AMK PHARMACY LLC
Other - Org Name:CRESTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-265-9399
Mailing Address - Street 1:29 E 198TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1802
Mailing Address - Country:US
Mailing Address - Phone:929-265-9399
Mailing Address - Fax:
Practice Address - Street 1:29 E 198TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1802
Practice Address - Country:US
Practice Address - Phone:929-265-9399
Practice Address - Fax:917-688-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy