Provider Demographics
NPI:1972931269
Name:FAST & FRIENDLY PHARMACY LLC
Entity Type:Organization
Organization Name:FAST & FRIENDLY PHARMACY LLC
Other - Org Name:FAST & FRIENDLY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-309-3943
Mailing Address - Street 1:140 EMPIRE BLVD
Mailing Address - Street 2:STORE #1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3316
Mailing Address - Country:US
Mailing Address - Phone:718-309-3943
Mailing Address - Fax:
Practice Address - Street 1:140 EMPIRE BLVD
Practice Address - Street 2:STORE # 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3316
Practice Address - Country:US
Practice Address - Phone:718-484-2300
Practice Address - Fax:347-663-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0323303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03910501Medicaid
2142649OtherPK