Provider Demographics
NPI:1134167125
Name:VILLY PHARMACY, INC.
Entity type:Organization
Organization Name:VILLY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-226-8971
Mailing Address - Street 1:179 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3762
Mailing Address - Country:US
Mailing Address - Phone:212-226-8971
Mailing Address - Fax:212-226-1633
Practice Address - Street 1:179 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3762
Practice Address - Country:US
Practice Address - Phone:212-226-8971
Practice Address - Fax:212-226-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0228433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01640335Medicaid
NY022843OtherNY STATE REGISTRATION NUM
3312636OtherNCPDP
3312636OtherNCPDP