Provider Demographics
NPI:1861623662
Name:GUY BREWER PHARMACY INC.
Entity type:Organization
Organization Name:GUY BREWER PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BATUROV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-525-5005
Mailing Address - Street 1:11717 GUY R BREWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2148
Mailing Address - Country:US
Mailing Address - Phone:718-525-5005
Mailing Address - Fax:718-525-5006
Practice Address - Street 1:11717 GUY R BREWER BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2148
Practice Address - Country:US
Practice Address - Phone:718-525-5005
Practice Address - Fax:718-525-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048499183500000X
333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
6319280001Medicare NSC