Organization
ST JUDE PHARMACY & SURGICAL SUPP
Active
Other names
ST JUDES PHCY AND SURG SPLY CORP
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL CHERVIN (SUPERVISING PHCST)
(718) 381-5116
Entity
Organization
Contact information
Practice address
121 SAINT NICHOLAS AVE, BROOKLYN, NY 11237-4043
(718) 381-5116
(718) 417-3621
Mailing address
121 SAINT NICHOLAS AVE, BROOKLYN, NY 11237-4043
(718) 381-5116
(718) 417-3621
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030756
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01061563
—
NY
01
—
3391478
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/09/2006
Last updated
10/03/2011
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