Provider Demographics
NPI:1851881429
Name:GREEN CHOICE PHARMACY INC
Entity Type:Organization
Organization Name:GREEN CHOICE PHARMACY INC
Other - Org Name:SIMON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSURMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORKULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-241-7070
Mailing Address - Street 1:10117 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2856
Mailing Address - Country:US
Mailing Address - Phone:718-997-7333
Mailing Address - Fax:718-997-7333
Practice Address - Street 1:10117 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2856
Practice Address - Country:US
Practice Address - Phone:718-997-7333
Practice Address - Fax:718-997-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04376821Medicaid