Provider Demographics
NPI:1821435793
Name:B & T WEST BRIGHTON PHARMACY INC.
Entity Type:Organization
Organization Name:B & T WEST BRIGHTON PHARMACY INC.
Other - Org Name:B & T PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROKHOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-273-7200
Mailing Address - Street 1:702 CASTETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310
Mailing Address - Country:US
Mailing Address - Phone:718-273-7200
Mailing Address - Fax:718-273-7355
Practice Address - Street 1:702 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1802
Practice Address - Country:US
Practice Address - Phone:718-273-7200
Practice Address - Fax:718-273-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140722OtherPK
NY6868720001Medicare NSC