Organization
AEN CORP
Active
Other names
JUNCTION BLVD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE MELANTHIOU (SUPERVISING PHARMACIST)
(718) 396-4030
Entity
Organization
Contact information
Practice address
95 53 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372
(718) 396-4030
(718) 396-3989
Mailing address
95 53 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372
(718) 396-4030
(718) 396-3989
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
024469
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02226653
—
NY
01
—
2060042
PK
—
Enumeration date
02/21/2007
Last updated
05/04/2016
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