Provider Demographics
NPI:1932120995
Name:ACJ PHARMACY CORP.
Entity Type:Organization
Organization Name:ACJ PHARMACY CORP.
Other - Org Name:VICTORIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-886-6200
Mailing Address - Street 1:44 45A KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3055
Mailing Address - Country:US
Mailing Address - Phone:718-886-6200
Mailing Address - Fax:718-886-6687
Practice Address - Street 1:44 45A KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3055
Practice Address - Country:US
Practice Address - Phone:718-886-6200
Practice Address - Fax:718-886-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336L0003X
NY0188873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064217OtherPK
NY00929460Medicaid
2064217OtherPK