Provider Demographics
NPI:1790880557
Name:KASSEL PHARMACY LTD
Entity Type:Organization
Organization Name:KASSEL PHARMACY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-464-0200
Mailing Address - Street 1:21811 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2124
Mailing Address - Country:US
Mailing Address - Phone:718-464-0200
Mailing Address - Fax:718-468-2493
Practice Address - Street 1:21811 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-2124
Practice Address - Country:US
Practice Address - Phone:718-464-0200
Practice Address - Fax:718-468-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016765333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00262620Medicaid
4073030001Medicare NSC