Provider Demographics
NPI:1740866961
Name:123 PHARMACY, INC.
Entity type:Organization
Organization Name:123 PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-666-8189
Mailing Address - Street 1:3712 PRINCE ST # F14
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4649
Mailing Address - Country:US
Mailing Address - Phone:718-971-1690
Mailing Address - Fax:718-971-1280
Practice Address - Street 1:3712 PRINCE ST # F14
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4649
Practice Address - Country:US
Practice Address - Phone:718-971-1690
Practice Address - Fax:718-971-1280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy