# 108 PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407626070
- **Authorized official:** ROMAN BADALOV (OWNER)
- **Authorized official phone:** (646) 752-0490

## Contact information

- **Practice address:** 4502 108TH ST, CORONA, NY 11368-2917
- **Practice address phone:** (718) 847-1982
- **Practice address fax:** (718) 228-4985
- **Mailing address:** 4502 108TH ST, CORONA, NY 11368-2917
- **Mailing address phone:** (718) 847-1982
- **Mailing address fax:** (718) 228-4985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/04/2024
- **Last updated:** 01/04/2024