Provider Demographics
NPI:1548307861
Name:AVENUE PHARMACY INC.
Entity type:Organization
Organization Name:AVENUE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-361-0436
Mailing Address - Street 1:1215 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 40TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-6107
Practice Address - Country:US
Practice Address - Phone:718-361-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021180333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01287636Medicaid
NY5530180001Medicare ID - Type Unspecified