Provider Demographics
NPI:1447527775
Name:ASCAN PHARMACY INC.
Entity type:Organization
Organization Name:ASCAN PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:FATA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-793-6747
Mailing Address - Street 1:11215 72ND ROAD
Mailing Address - Street 2:UNIT LL5
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6647
Mailing Address - Country:US
Mailing Address - Phone:718-793-6747
Mailing Address - Fax:718-228-7166
Practice Address - Street 1:11215 72ND ROAD
Practice Address - Street 2:LL5
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6647
Practice Address - Country:US
Practice Address - Phone:718-793-6747
Practice Address - Fax:718-228-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0310953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5804427OtherNCPDP
NY03432648Medicaid
5804427OtherNCPDP