Provider Demographics
NPI:1952685612
Name:CO-OP CITY PHARMACY, INC
Entity Type:Organization
Organization Name:CO-OP CITY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARKADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYZNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-703-1811
Mailing Address - Street 1:161 EINSTEIN LOOP
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4902
Mailing Address - Country:US
Mailing Address - Phone:718-708-8171
Mailing Address - Fax:718-708-8172
Practice Address - Street 1:161 EINSTEIN LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4902
Practice Address - Country:US
Practice Address - Phone:718-708-8171
Practice Address - Fax:718-708-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6608020001Medicare NSC