16TH Ave Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

16TH AVE PHARMACY LLC

Practice address

4605 16TH Ave
Brooklyn, NY 11204-1105

Phone

(718) 686-8000

Fax

(718) 686-8001

NPI assigned

Apr 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Solomon GulyamovNPI 1144645771

Title

Owner

Phone

(718) 686-8000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Solomon Gulyamov, PHARM.D.

  • Pharmacist
  • Brooklyn, NY
  • NPI 1144645771
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1285254367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 16TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041105",
            "telephone_number": "718-686-8000",
            "fax_number": "718-686-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 16TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112041105",
            "telephone_number": "718-686-8000",
            "fax_number": "718-686-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "16TH AVE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "GULYAMOV",
        "authorized_official_first_name": "SOLOMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-686-8000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 1771 Utica LLC

• Community/Retail Pharmacy in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.