Provider Demographics
NPI:1205352002
Name:CHEMPLUS PHARMACY CORP
Entity type:Organization
Organization Name:CHEMPLUS PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYORINDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-282-5504
Mailing Address - Street 1:648 SCHROEDERS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2234
Mailing Address - Country:US
Mailing Address - Phone:718-282-5504
Mailing Address - Fax:718-282-5505
Practice Address - Street 1:2606 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4152
Practice Address - Country:US
Practice Address - Phone:718-282-5504
Practice Address - Fax:718-282-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0357003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05082724Medicaid
2171129OtherPK