Grand Avenue Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

012597 Issued in NY

Legal business name

GRAND AVENUE PHARMACY INC

Practice address

69 29 Grand Ave
Maspeth, NY 11378-1895

Phone

(718) 898-6882

Fax

(718) 898-2504

NPI assigned

Jun 12, 2006

Organization subpart

No

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

Authorized official

Name

Anthony TerraccianoNPI 1902129356

Title

President Sup RPH

Phone

(718) 898-6882

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• GRAND AVENUE PHARMACY INC Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

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

Practitioners 2

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

• Anthony Joseph Terracciano, RPH

  • Pharmacist
  • Maspeth, NY
  • NPI 1902129356
  NPD Authorized official
• Alfred Desimone, RPH

  • Pharmacist
  • Maspeth, NY
  • NPI 1720302169
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1760424055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 29 GRAND AVE",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113781895",
            "telephone_number": "718-898-6882",
            "fax_number": "718-898-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 29 GRAND AVE",
            "city": "MASPETH",
            "state": "NY",
            "postal_code": "113781895",
            "telephone_number": "718-898-6882",
            "fax_number": "718-898-2504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVENUE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "TERRACCIANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT SUP RPH",
        "authorized_official_telephone_number": "718-898-6882"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "012597",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01046955",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2059246",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND AVENUE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gina Marie Gomez-Sabin, M.ED TSHH
• Catherine Gonzales, LPN
• Melinda Gonzalez
• Grand Ambulette Service ,Inc.
• Grand Ave Chemists Inc
• Grand Avenue Services Inc
• Grand Care Pharmacy Inc
• Grand Care Pharmacy Inc.
• Grand Smile Dental
• Grand Spectacle Inc.

• Community/Retail Pharmacy in Maspeth, NY
• Providers in Maspeth, 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 16, 2015; 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.