# REVIVAL PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CITYWIDE PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629347414
- **Authorized official:** MOSHE SOSKIN (COO)
- **Authorized official phone:** (718) 298-2222

## Contact information

- **Practice address:** 5369 KINGS HWY, BROOKLYN, NY 11203-6704
- **Practice address phone:** (718) 298-2222
- **Practice address fax:** (718) 298-3333
- **Mailing address:** 5359B KINGS HIGHWAY, BROOKLYN, NY 11203
- **Mailing address phone:** (718) 298-2222
- **Mailing address fax:** (718) 298-3333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 28RO00134300 | NJ | — |
| 3336C0003X | Community/Retail Pharmacy | 030991 | NY | — |
| 3336L0003X | Long Term Care Pharmacy | 0003191 | CT | Yes |
| 3336L0003X | Long Term Care Pharmacy | NP000806 | PA | — |

## Other

- **Enumeration date:** 12/22/2011
- **Last updated:** 03/28/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03398001 | — | NY |
| 05 | — | 103260623 | — | PA |
| 01 | — | 2134031 | PK | — |