Organization
AIIE CORP
Active
Other names
Primemed Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VYACHESLAV FATTAKHOV (PRESIDENT)
(718) 872-9772
Entity
Organization
Contact information
Practice address
12084 QUEENS BLVD, KEW GARDENS, NY 11415-1204
(718) 872-9772
(646) 813-1803
Mailing address
120-84 QUEENS BLVD, KEW GARDENS, NY 11415
(718) 872-9772
(646) 813-1803
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
035838
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2175280
PK
—
Enumeration date
12/21/2017
Last updated
10/23/2020
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