Organization
GRAND AVENUE PHARMACY INC
Active
Other names
GRAND AVENUE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY TERRACCIANO (PRESIDENT SUP RPH)
(718) 898-6882
Entity
Organization
Contact information
Practice address
69 29 GRAND AVE, MASPETH, NY 11378-1895
(718) 898-6882
(718) 898-2504
Mailing address
69 29 GRAND AVE, MASPETH, NY 11378-1895
(718) 898-6882
(718) 898-2504
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
012597
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01046955
—
NY
01
—
2059246
PK
—
Enumeration date
06/12/2006
Last updated
04/16/2015
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