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Organization
BB MYRTLE PHARMACY CORP
Active
Organization
BB MYRTLE PHARMACY CORP
Active
Other names
Vitacare Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS NATENZON (CEO)
(718) 720-3710
Entity
Organization
Contact information
Practice address
141 CHARLES AVE, STATEN ISLAND, NY 10302-1624
(718) 720-5604
(718) 770-7687
Mailing address
826 FOREST AVE, STATEN ISLAND, NY 10310-2446
(718) 720-3710
(718) 360-9650
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
029308
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119345
PK
—
05
—
3056122
—
NY
Enumeration date
11/12/2008
Last updated
11/17/2021
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