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Organization
WOODHAVEN CHEMIST CORP.
Active
Organization
WOODHAVEN CHEMIST CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGOR MATATOV (PRESIDENT)
(718) 441-7111
Entity
Organization
Contact information
Practice address
8622 JAMAICA AVE, WOODHAVEN, NY 11421-2005
(347) 836-3966
Mailing address
6939 178TH ST, FRESH MEADOWS, NY 11365-3442
(718) 441-7111
(718) 441-8111
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055993
STATE LICENSE
NY
Enumeration date
08/16/2018
Last updated
04/21/2021
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