# BLONDELL RX NY LLC

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

## Provider details

- **NPI number:** 1992234454
- **Authorized official:** MAYA BASIN (PIC)
- **Authorized official phone:** (718) 819-5249

## Contact information

- **Practice address:** 1047 SURF AVE FL 2, BROOKLYN, NY 11224-2810
- **Practice address phone:** (718) 819-5249
- **Practice address fax:** (917) 722-0851
- **Mailing address:** 1047 SURF AVE FL 2, BROOKLYN, NY 11224-2810
- **Mailing address phone:** (212) 249-8202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2017
- **Last updated:** 10/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05730387 | — | NY |