Provider Demographics
NPI:1487059085
Name:COMPREHENSIVE CHEMISTS, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE CHEMISTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YEFIM
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:917-892-4215
Mailing Address - Street 1:69-21 164TH STREET
Mailing Address - Street 2:STORE 3
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:718-969-1600
Mailing Address - Fax:718-969-1602
Practice Address - Street 1:69-21 164TH STREET
Practice Address - Street 2:STORE 3
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-969-1600
Practice Address - Fax:718-969-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAYWQMedicaid
NYAYWQMedicaid