Basic Information
| Provider Information | |||||||||
| NPI: | 1619311503 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YAFFA PHARMACY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 FOSTER AVE | ||||||||
| Address2: | |||||||||
| City: | 1211 FOSTER AVE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186456434 | ||||||||
| FaxNumber: | 7183602279 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 FOSTER AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112301607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186456434 | ||||||||
| FaxNumber: | 7183602279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2013 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | GARBER | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7186456434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 044704 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 044704 | 01 | NY | RPH | OTHER |