Provider Demographics
NPI: | 1861476384 |
---|---|
Name: | EVE 4 PHARMACY |
Entity Type: | Organization |
Organization Name: | EVE 4 PHARMACY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ALLA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHIKHMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 718-743-8585 |
Mailing Address - Street 1: | 1634 BROADWAY |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11207-1026 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-573-5555 |
Mailing Address - Fax: | 718-573-3240 |
Practice Address - Street 1: | 1634 BROADWAY |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11207-1026 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-573-5555 |
Practice Address - Fax: | 718-573-3240 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-11-30 |
Last Update Date: | 2008-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 026094 | 333600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 5023560001 | Medicare NSC |