Organization
BAY RIDGE SPECIALTY PHARMACY, LLC
Active
Other names
Bayridge Specialty Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
IGOR GRABOV (MANAGING MEMBER)
(718) 745-6800
Entity
Organization
Contact information
Practice address
7618 5TH AVE, BROOKLYN, NY 11209-3304
(718) 745-6800
(718) 745-6850
Mailing address
7618 5TH AVE, BROOKLYN, NY 11209-3304
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
029206
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3360106
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/17/2009
Last updated
03/17/2009
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