Organization
KISSENA RX PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY TEOH (PHARMACIST)
(917) 563-1079
Entity
Organization
Contact information
Practice address
4207 KISSENA BLVD, FLUSHING, NY 11355-3297
(917) 563-1079
(917) 563-1023
Mailing address
4207 KISSENA BLVD, FLUSHING, NY 11355-3297
(917) 563-1079
(917) 563-1023
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038034
PHARMACY STATE LICENSE
NY
05
—
06323317
—
NY
Enumeration date
05/01/2020
Last updated
03/31/2022
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