NPIMap

Organization Active NPI

Revival Pharmacy LLC

Doing business as Citywide Pharmacy

  • Long Term Care Pharmacy
  • Brooklyn, NY
National Provider Identifier
1629347414
Registry record updated Mar 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
0003191 Issued in CT
Legal business name
REVIVAL PHARMACY LLC
Doing business as
Citywide Pharmacy
Practice address
5369 Kings Hwy
Brooklyn, NY 11203-6704
Phone
(718) 298-2222
Fax
(718) 298-3333
NPI assigned
Dec 22, 2011
Last updated
Mar 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2017

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

Authorized official

Name
Moshe SoskinNPI 1750870622
Title
Coo
Phone
(718) 298-2222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 28RO00134300 NJ
Community/Retail Pharmacy 3336C0003X 030991 NY
Long Term Care Pharmacy 3336L0003X NP000806 PA
Long Term Care Pharmacy 3336L0003X 0003191 CT Primary

Addresses

Primary practice location

5369 Kings Hwy
Brooklyn, NY 11203-6704

Mailing address

5359B Kings Highway
Brooklyn, NY 11203
Phone (718) 298-2222

Other identifiers 3

IdentifierTypeStateIssuer
103260623MedicaidPA
2134031OtherPK
03398001MedicaidNY

Other names 1

  • CITYWIDE PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

5359 Kings Hwy
#B
Brooklyn, NY 11203

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490659200000",
    "number": "1629347414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5359B KINGS HIGHWAY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-298-2222",
            "fax_number": "718-298-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5369 KINGS HWY",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112036704",
            "telephone_number": "718-298-2222",
            "fax_number": "718-298-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2017-03-28",
        "status": "A",
        "authorized_official_last_name": "SOSKIN",
        "authorized_official_first_name": "MOSHE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "718-298-2222"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NJ",
            "license": "28RO00134300",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030991",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "PA",
            "license": "NP000806",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CT",
            "license": "0003191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103260623",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2134031",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03398001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CITYWIDE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; 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.