Provider Demographics
NPI:1356768899
Name:DANA PHARMACY, INC
Entity type:Organization
Organization Name:DANA PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SUKYUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-224-3233
Mailing Address - Street 1:24812 NORTHERN BLVD
Mailing Address - Street 2:1C
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1206
Mailing Address - Country:US
Mailing Address - Phone:718-224-3233
Mailing Address - Fax:
Practice Address - Street 1:24812 NORTHERN BLVD
Practice Address - Street 2:1C
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1206
Practice Address - Country:US
Practice Address - Phone:718-224-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-22
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17032699333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7218550001Medicare NSC