Provider Demographics
NPI:1912145947
Name:UNIVERSAL PHARMACY DEPOT INC.
Entity Type:Organization
Organization Name:UNIVERSAL PHARMACY DEPOT INC.
Other - Org Name:TRADITIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-804-0101
Mailing Address - Street 1:1206 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5204
Mailing Address - Country:US
Mailing Address - Phone:718-787-2300
Mailing Address - Fax:718-382-3988
Practice Address - Street 1:1206 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5204
Practice Address - Country:US
Practice Address - Phone:718-787-2300
Practice Address - Fax:718-382-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy