Fulton Mall Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

031313 Issued in NY

Legal business name

FULTON MALL PHARMACY INC

Practice address

540 Fulton St
Brooklyn, NY 11201-5308

Phone

(718) 855-7979

Fax

(718) 855-1123

NPI assigned

Apr 10, 2012

Organization subpart

No

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

Authorized official

Name

Shalom KikovNPI 1942566377

Title

President/Supervising RPH

Phone

(718) 855-7979

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fulton Mall pharmacy Inc Doing business as

Practitioners 1

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

• Shalom Sam Kikov

  • Pharmacist
  • Brooklyn, NY
  • NPI 1942566377
  NPD (past) Authorized official

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343001600000",
    "number": "1295091627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015308",
            "telephone_number": "718-855-7979",
            "fax_number": "718-855-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015308",
            "telephone_number": "718-855-7979",
            "fax_number": "718-855-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON MALL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2012-07-23",
        "status": "A",
        "authorized_official_last_name": "KIKOV",
        "authorized_official_first_name": "SHALOM",
        "authorized_official_title_or_position": "PRESIDENT/SUPERVISING RPH",
        "authorized_official_telephone_number": "718-855-7979"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "031313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5805619",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fulton Mall pharmacy Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Clifford Fulmore, DPT
• Fulton 1St Pharmacy, Inc
• Fulton 1St Pharmacy, Inc
• Fulton Dental PC
• Fulton Drugs Inc
• Fulton Medical Group PC
• Fulton Medical Plaza, P.C.
• Fulton Pharmacy Inc
• Fulton RX Inc.
• Fulton St Pharmacy Inc

• 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 Jul 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.