Provider Demographics
NPI:1356767065
Name:AUBURNDALE PHARMACY INC.
Entity type:Organization
Organization Name:AUBURNDALE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-352-3200
Mailing Address - Street 1:19215 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19215 47TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3906
Practice Address - Country:US
Practice Address - Phone:718-352-3200
Practice Address - Fax:718-352-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0325683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7148350001Medicare NSC