Organization
MYRTLE RX LLC
Active
Other names
Myrtle Drugs
Organization subpart
No
Provider details
NPI number
Authorized official
PETE SUTARIA (MEMBER)
(718) 453-6200
Entity
Organization
Contact information
Practice address
1454 MYRTLE AVE, BROOKLYN, NY 11237-5102
(718) 453-6200
(718) 455-3226
Mailing address
1454 MYRTLE AVE, BROOKLYN, NY 11237-5102
(718) 453-6200
(718) 455-3226
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031019
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03361300
—
NY
01
—
2133119
PK
—
Enumeration date
08/16/2011
Last updated
09/22/2016
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