Provider Demographics
NPI:1891199584
Name:EXPRESS PHARMACY, INC.
Entity Type:Organization
Organization Name:EXPRESS PHARMACY, INC.
Other - Org Name:AMIABLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-304-6261
Mailing Address - Street 1:1108 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2922
Mailing Address - Country:US
Mailing Address - Phone:718-827-7528
Mailing Address - Fax:
Practice Address - Street 1:1108 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2922
Practice Address - Country:US
Practice Address - Phone:718-827-7528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7331050001Medicare NSC