Organization
80TH STREET PHARMACY INC
Active
Other names
Pure Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOKMAN (PRESIDENT)
(718) 236-2747
Entity
Organization
Contact information
Practice address
8014 18TH AVE, BROOKLYN, NY 11214-1706
(718) 236-2747
(718) 236-2723
Mailing address
8014 18TH AVE, BROOKLYN, NY 11214-1706
(718) 236-2747
(718) 236-2723
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031140
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135172
PK
—
Enumeration date
05/01/2012
Last updated
10/14/2016
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