Organization
12116 LIBERTY AVENUE DRUGS INC.
Active
Other names
CPW Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE SHANAZ BACCHUS-QUDDUS III (SECRETARY)
(718) 322-4900
Entity
Organization
Contact information
Practice address
12116 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2112
(718) 322-4900
(718) 322-3121
Mailing address
12116 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-2112
(718) 322-4900
(718) 322-3121
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
027272
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02673476
—
NY
Enumeration date
10/10/2006
Last updated
06/13/2008
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