Provider Demographics
NPI:1902916380
Name:PRESCRIPTION HEADQUARTERS FLUSHING PLAZA INC
Entity Type:Organization
Organization Name:PRESCRIPTION HEADQUARTERS FLUSHING PLAZA INC
Other - Org Name:FLUSHING PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAELI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-961-9393
Mailing Address - Street 1:41 63 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-961-9393
Mailing Address - Fax:718-961-9515
Practice Address - Street 1:41 63 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-961-9393
Practice Address - Fax:718-961-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00920796Medicaid
3385209Medicare UPIN
NY00920796Medicaid