Provider Demographics
NPI:1669582334
Name:EMCON PHARMACY INC
Entity type:Organization
Organization Name:EMCON PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHUSIAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHAGROO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-789-3370
Mailing Address - Street 1:49 FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217
Mailing Address - Country:US
Mailing Address - Phone:718-789-3370
Mailing Address - Fax:718-789-1490
Practice Address - Street 1:49 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217
Practice Address - Country:US
Practice Address - Phone:718-789-3370
Practice Address - Fax:718-789-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0380003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00577519Medicaid
NY5158210001Medicare ID - Type Unspecified