Provider Demographics
NPI:1871506337
Name:353 EMPIRE PHARMACY INC
Entity Type:Organization
Organization Name:353 EMPIRE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NUCHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-687-0497
Mailing Address - Street 1:505 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1395
Mailing Address - Country:US
Mailing Address - Phone:718-467-0918
Mailing Address - Fax:718-774-3078
Practice Address - Street 1:505 UNION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1395
Practice Address - Country:US
Practice Address - Phone:718-467-0918
Practice Address - Fax:718-774-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01176732Medicaid
NY4537780001Medicare NSC