Provider Demographics
NPI:1053601831
Name:FRIENDS PHARMACY INC
Entity type:Organization
Organization Name:FRIENDS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYTBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-753-4900
Mailing Address - Street 1:342 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1478
Mailing Address - Country:US
Mailing Address - Phone:718-753-4900
Mailing Address - Fax:718-753-4939
Practice Address - Street 1:342 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1478
Practice Address - Country:US
Practice Address - Phone:718-753-4900
Practice Address - Fax:718-753-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030710333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5802625OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03341031Medicaid
5802625OtherNCPDP PROVIDER IDENTIFICATION NUMBER