Provider Demographics
NPI:1821102716
Name:AUSTRA LINE PHARMACY INC.
Entity Type:Organization
Organization Name:AUSTRA LINE PHARMACY INC.
Other - Org Name:AUSTRA LINE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHINEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBASIONWE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-531-6000
Mailing Address - Street 1:5916 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1817
Mailing Address - Country:US
Mailing Address - Phone:718-531-6000
Mailing Address - Fax:718-531-6004
Practice Address - Street 1:5916 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1817
Practice Address - Country:US
Practice Address - Phone:718-531-6000
Practice Address - Fax:718-531-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
NY0278303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2858006Medicaid
2068227OtherPK
5764960001Medicare NSC