Organization
MILL BASIN PHARMACY INC
Active
Other names
Mill Basin Pharmacy, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA GUREVICH (PRESIDENT)
(718) 676-6675
Entity
Organization
Contact information
Practice address
5829 AVENUE T, BROOKLYN, NY 11234-4111
(718) 676-6675
(718) 676-6268
Mailing address
5829 AVENUE T, BROOKLYN, NY 11234-4111
(718) 676-6675
(718) 676-6268
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031105
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03462526
—
NY
01
—
2134186
PK
—
Enumeration date
03/27/2012
Last updated
02/05/2016
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