Provider Demographics
NPI:1932628427
Name:YAR TRADING CORP
Entity Type:Organization
Organization Name:YAR TRADING CORP
Other - Org Name:PEWEX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMAIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STANISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-456-6667
Mailing Address - Street 1:66-19 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3310
Mailing Address - Country:US
Mailing Address - Phone:718-456-6667
Mailing Address - Fax:718-456-6668
Practice Address - Street 1:6619 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3310
Practice Address - Country:US
Practice Address - Phone:718-456-6667
Practice Address - Fax:718-456-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0354683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04949482Medicaid
NY04866395Medicaid
2171937OtherPK