Provider Demographics
NPI:1487063830
Name:NY PHARMACY & COMPOUNDING CENTER INC.
Entity type:Organization
Organization Name:NY PHARMACY & COMPOUNDING CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDRABOUH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-403-5151
Mailing Address - Street 1:3715 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1993
Mailing Address - Country:US
Mailing Address - Phone:718-406-9653
Mailing Address - Fax:718-406-9654
Practice Address - Street 1:3715 23RD AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1993
Practice Address - Country:US
Practice Address - Phone:718-406-9653
Practice Address - Fax:718-406-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328423336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy