Provider Demographics
NPI:1902897259
Name:ELM PHARMACY, INC.
Entity Type:Organization
Organization Name:ELM PHARMACY, INC.
Other - Org Name:ELM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIB
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-336-8300
Mailing Address - Street 1:1651 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5849
Mailing Address - Country:US
Mailing Address - Phone:718-336-8300
Mailing Address - Fax:718-336-8421
Practice Address - Street 1:1651 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5849
Practice Address - Country:US
Practice Address - Phone:718-336-8300
Practice Address - Fax:718-336-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022262333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01633985Medicaid
NYA1298567OtherOXFORD DME PROVIDER #
NY3369988OtherNABP OR NCPDP
NY01633985Medicaid