Provider Demographics
NPI:1144038803
Name:WOODHAVEN CHEMIST CORP.
Entity type:Organization
Organization Name:WOODHAVEN CHEMIST CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATATOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-836-3966
Mailing Address - Street 1:8622 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2005
Mailing Address - Country:US
Mailing Address - Phone:718-441-7111
Mailing Address - Fax:
Practice Address - Street 1:8622 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2005
Practice Address - Country:US
Practice Address - Phone:718-441-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy