Organization
ABC SOURCE LLC
Active
Other names
ABC Source Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KEYONG ZHENG (ADMIN)
(718) 676-5556
Entity
Organization
Contact information
Practice address
5110 8TH AVE, BROOKLYN, NY 11220-2803
(718) 676-5556
(646) 829-9181
Mailing address
5110 8TH AVE, BROOKLYN, NY 11220-2803
(718) 676-5556
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
033311
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04172423
—
NY
01
—
2151480
PK
—
Enumeration date
04/11/2015
Last updated
05/09/2023
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