Provider Demographics
NPI:1851612915
Name:AMAZON PHARMACY INC.
Entity Type:Organization
Organization Name:AMAZON PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIGLIOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOLMAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-986-3433
Mailing Address - Street 1:42-10 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:718-768-0707
Mailing Address - Fax:718-786-0709
Practice Address - Street 1:42-10 43RD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:718-768-0707
Practice Address - Fax:718-786-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170301413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03261007Medicaid
6451400001Medicare NSC