Provider Demographics
NPI:1932245875
Name:ASHLAND PHARMACY INC.
Entity Type:Organization
Organization Name:ASHLAND PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACISTS-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:GBENEBITSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH,MS
Authorized Official - Phone:718-834-9884
Mailing Address - Street 1:123 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1237
Mailing Address - Country:US
Mailing Address - Phone:718-834-9884
Mailing Address - Fax:718-834-9567
Practice Address - Street 1:123 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1237
Practice Address - Country:US
Practice Address - Phone:718-834-9884
Practice Address - Fax:718-834-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0209743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3374802OtherNABP
NY4718770001Medicare NSC