Provider Demographics
NPI:1821534694
Name:PITKIN EXPRESS CARE PHARMACY INC
Entity Type:Organization
Organization Name:PITKIN EXPRESS CARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-627-4778
Mailing Address - Street 1:1672 PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5605
Mailing Address - Country:US
Mailing Address - Phone:347-627-4778
Mailing Address - Fax:347-627-4779
Practice Address - Street 1:1672 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5605
Practice Address - Country:US
Practice Address - Phone:347-627-4778
Practice Address - Fax:347-627-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0352953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167323OtherPK