Organization
BRADDOCK PHARMACY LLC
Active
Other names
Braddock Pharmacy LLC.
Organization subpart
No
Provider details
NPI number
Authorized official
KALIOPE CHIONIS (SUPERVISING PHARMACIST)
(718) 347-1516
Entity
Organization
Contact information
Practice address
23601A BRADDOCK AVE, BELLEROSE, NY 11426-1143
(718) 347-1516
(718) 347-1789
Mailing address
236-01A BRADDOCK AVE., BELLEROSE, NY 11426
(718) 347-1516
(718) 347-1789
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
032318
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04396690
—
NY
01
—
2142918
PK
—
Enumeration date
11/15/2013
Last updated
07/19/2018
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