Provider Demographics
NPI:1053624536
Name:QUEENS CENTRAL PHARMACY INC
Entity type:Organization
Organization Name:QUEENS CENTRAL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-268-8060
Mailing Address - Street 1:11608 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7055
Mailing Address - Country:US
Mailing Address - Phone:718-268-8060
Mailing Address - Fax:718-268-8070
Practice Address - Street 1:11608 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7055
Practice Address - Country:US
Practice Address - Phone:718-268-8060
Practice Address - Fax:718-268-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0301713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126121OtherPK
NY3268742Medicaid