Provider Demographics
NPI:1821411059
Name:A & L PHARMACY CORP
Entity type:Organization
Organization Name:A & L PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYADZHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-318-5000
Mailing Address - Street 1:11514 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2206
Mailing Address - Country:US
Mailing Address - Phone:718-318-5000
Mailing Address - Fax:718-318-5002
Practice Address - Street 1:11514 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2206
Practice Address - Country:US
Practice Address - Phone:718-318-5000
Practice Address - Fax:718-318-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
032532OtherNYS STATE LICENSE
1821411059OtherNPI
5809679OtherNCPDP
FA4359510OtherDEA
032532OtherNYS STATE LICENSE