Provider Demographics
NPI:1245569342
Name:MODERN CHEMIST LLC
Entity type:Organization
Organization Name:MODERN CHEMIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:URRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-369-6100
Mailing Address - Street 1:189 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3013
Mailing Address - Country:US
Mailing Address - Phone:718-369-6100
Mailing Address - Fax:718-369-6101
Practice Address - Street 1:189 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3013
Practice Address - Country:US
Practice Address - Phone:718-369-6100
Practice Address - Fax:718-369-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3364267OtherNCPDP PROVIDER IDENTIFICATION NUMBER