Provider Information for 1811903594
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HAVEN PHARMACY
Other Names:Doing Business As:PANACEA PHARMACYOrganization Subpart: NO
NPI: 1811903594
Last Updated: 2009-09-30
Certification Date:
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Details
Name | Value | ||||||||||||
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NPI | 1811903594 | ||||||||||||
Enumeration Date | 2006-08-01 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: VIKTORIA GRINBLAT Title: RPH, SP, SECRETARY Phone: 7183829616 | ||||||||||||
Mailing Address | 1211 AVENUE U BROOKLYN, NY 11229-4108 United States Phone: 718-382-9616 | Fax:718-382-9615 | ||||||||||||
Primary Practice Address | 1211 AVENUE U BROOKLYN, NY 11229-4108 United States Phone: 718-382-9616 | Fax:718-382-9615 | ||||||||||||
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