Provider Demographics
NPI:1376640292
Name:OCEANA EXPRESS PHARMACY, INC
Entity type:Organization
Organization Name:OCEANA EXPRESS PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENEGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-9666
Mailing Address - Street 1:2009 AVE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3701
Mailing Address - Country:US
Mailing Address - Phone:718-676-9666
Mailing Address - Fax:718-232-0034
Practice Address - Street 1:2009 AVE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3701
Practice Address - Country:US
Practice Address - Phone:718-676-9666
Practice Address - Fax:718-232-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0273363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694806Medicaid
3346865OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3346865OtherNCPDP PROVIDER IDENTIFICATION NUMBER