63 Lee Ave Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

013502 Issued in NY

Legal business name

63 LEE AVE PHARMACY INC

Doing business as

Stuart Slater Pharmacy

Practice address

63 Lee Ave
Brooklyn, NY 11211-7213

Phone

(718) 387-2852

Fax

(718) 388-4376

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Stuart Slater, RPHNPI 1205381795

Title

Pres SPH

Phone

(718) 387-2852

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Stuart Slater Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

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

• Stuart Slater

  • Pharmacist
  • Brooklyn, NY
  • NPI 1205381795
  NPD Authorized official
• Beth Slater, RPH

  • Pharmacist
  • Brooklyn, NY
  • NPI 1649989419
  NPD

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1710002878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 LEE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112117213",
            "telephone_number": "718-387-2852",
            "fax_number": "718-388-4376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 LEE AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112117213",
            "telephone_number": "718-387-2852",
            "fax_number": "718-388-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "63 LEE AVE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "SLATER",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "PRES SPH",
        "authorized_official_telephone_number": "718-387-2852",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "013502",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "013502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00268644",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3326902",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3326902",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stuart Slater Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.