Organization
BRANAC NY LLC
Active
Other names
CONEY ISLAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA MOISEYEV (PIC)
(718) 333-2525
Entity
Organization
Contact information
Practice address
2720 MERMAID AVE, BROOKLYN, NY 11224-2006
(718) 333-2525
(718) 333-0955
Mailing address
1047 SURF AVE, 2ND FLOOR, BROOKLYN, NY 11224-2810
(212) 249-8202
(917) 722-0851
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02091532
—
NY
01
—
038236
PHARMACY LICENSE
—
01
—
2062608
PK
—
Enumeration date
09/20/2006
Last updated
10/04/2023
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