Provider Demographics
NPI:1235955774
Name:WS 125 GREAVES LN CORP
Entity type:Organization
Organization Name:WS 125 GREAVES LN CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAJDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUZAHRIEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-887-0022
Mailing Address - Street 1:125N GREAVES LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2175
Mailing Address - Country:US
Mailing Address - Phone:718-887-0022
Mailing Address - Fax:718-887-0023
Practice Address - Street 1:125N GREAVES LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2175
Practice Address - Country:US
Practice Address - Phone:718-887-0022
Practice Address - Fax:718-887-0023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WS 125 GREAVES LN CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-30
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty