# 63 LEE AVE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Stuart Slater Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710002878
- **Authorized official:** MR. STUART SLATER RPH (PRES SPH)
- **Authorized official phone:** (718) 387-2852

## Contact information

- **Practice address:** 63 LEE AVE, BROOKLYN, NY 11211-7213
- **Practice address phone:** (718) 387-2852
- **Practice address fax:** (718) 388-4376
- **Mailing address:** 63 LEE AVE, BROOKLYN, NY 11211-7213
- **Mailing address phone:** (718) 387-2852
- **Mailing address fax:** (718) 388-4376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 013502 | NY | — |
| 333600000X | Pharmacy | 013502 | NY | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 03/08/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00268644 | — | NY |
| 01 | — | 3326902 | NCPDP NUMBER | NY |