Provider Demographics
NPI:1356172969
Name:AVENUE O PHARMACY INC
Entity type:Organization
Organization Name:AVENUE O PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COOPER
Authorized Official - Middle Name:SIU WAI
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-758-5096
Mailing Address - Street 1:26 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6021
Mailing Address - Country:US
Mailing Address - Phone:718-758-5096
Mailing Address - Fax:718-758-5086
Practice Address - Street 1:26 AVENUE O
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6021
Practice Address - Country:US
Practice Address - Phone:718-758-5096
Practice Address - Fax:718-758-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy