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Organization

BLONDELL RX NY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAYA BASIN (PIC)
(718) 819-5249
Entity
Organization

Contact information

Practice address
1047 SURF AVE FL 2, BROOKLYN, NY 11224-2810
(718) 819-5249
(917) 722-0851
Mailing address
1047 SURF AVE FL 2, BROOKLYN, NY 11224-2810
(212) 249-8202

Taxonomy

Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05730387
NY
Enumeration date
06/08/2017
Last updated
10/04/2023
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