Basic Information
| Provider Information | |||||||||
| NPI: | 1225181308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NY FAMILY PHARMACY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14246 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113546042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188880808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14246 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113546042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188880808 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | LEEKIM | ||||||||
| AuthorizedOfficialFirstName: | OUNSIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7188880808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 02385335 | 05 | NY | MEDICAID |