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NPI Code Detail

MEDICARE: BRONXDALE PHARMACY INC

MEDICARE: BRONXDALE PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy019422NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11134299548OTHERNYNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33389992OTHERNCPDP

General Provider Information

NPI Number : 1134299548
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRONXDALE PHARMACY INC
Provider Business Mailing Address
First Line : 1706 WATSON AVENUE
Second Line :
City : BRONX
State : NY
Zip : 10472-5408
Country : US
Telephone Number : 718-542-0440
Fax Number : 718-378-1693
Provider Business Practice Location Address
First Line : 1706 WATSON AVENUE
Second Line :
City : BRONX
State : NY
Zip : 10472-5408
Country : US
Telephone Number : 718-542-0440
Fax Number : 718-378-1693
Authorized Official
Title or Position : CORPORATE OFFICER
Name : MS. VALERIE E HENRY
Credential : RPH
Telephone Number : 718-542-0440
Provider Enumeration Date : 11/09/2006
Last Update Date : 02/28/2008

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Directions to “BRONXDALE PHARMACY INC ” Practice Location

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