Provider Demographics
NPI:1902051618
Name:FOUR B'S PHARMACY INC
Entity Type:Organization
Organization Name:FOUR B'S PHARMACY INC
Other - Org Name:FOUR B'S PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-270-3454
Mailing Address - Street 1:4035 95TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-6206
Mailing Address - Country:US
Mailing Address - Phone:718-205-2411
Mailing Address - Fax:718-205-2227
Practice Address - Street 1:4035 95TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-6206
Practice Address - Country:US
Practice Address - Phone:718-205-2411
Practice Address - Fax:718-205-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0292023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118129OtherPK
NY3063494Medicaid