Organization
REVIVAL PHARMACY LLC
Active
Other names
CITYWIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MOSHE SOSKIN (COO)
(718) 298-2222
Entity
Organization
Contact information
Practice address
5369 KINGS HWY, BROOKLYN, NY 11203-6704
(718) 298-2222
(718) 298-3333
Mailing address
5359B KINGS HIGHWAY, BROOKLYN, NY 11203
(718) 298-2222
(718) 298-3333
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
28RO00134300
NJ
3336C0003X
Community/Retail Pharmacy
030991
NY
3336L0003X
Long Term Care Pharmacy
Primary
0003191
CT
3336L0003X
Long Term Care Pharmacy
NP000806
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03398001
—
NY
05
—
103260623
—
PA
01
—
2134031
PK
—
Enumeration date
12/22/2011
Last updated
03/28/2017
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