# KISSENA RX PHARMACY INC

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

## Provider details

- **NPI number:** 1437770310
- **Authorized official:** BRADLEY TEOH (PHARMACIST)
- **Authorized official phone:** (917) 563-1079

## Contact information

- **Practice address:** 4207 KISSENA BLVD, FLUSHING, NY 11355-3297
- **Practice address phone:** (917) 563-1079
- **Practice address fax:** (917) 563-1023
- **Mailing address:** 4207 KISSENA BLVD, FLUSHING, NY 11355-3297
- **Mailing address phone:** (917) 563-1079
- **Mailing address fax:** (917) 563-1023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/01/2020
- **Last updated:** 03/31/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 038034 | PHARMACY STATE LICENSE | NY |
| 05 | — | 06323317 | — | NY |