MEDICARE: 158TH STREET NEIGHBORHOOD PHARMACY, LLC

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
1	333600000X	Pharmacy	026148	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528139318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	158TH STREET NEIGHBORHOOD PHARMACY, LLC

Provider Business Mailing Address
First Line	:	3103 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4688
Country	:	US
Telephone Number	:	718-585-6188
Fax Number	:	718-585-6653

Provider Business Practice Location Address
First Line	:	3103 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4688
Country	:	US
Telephone Number	:	718-585-6188
Fax Number	:	718-585-6653

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. JOSEPH TEMPELBERG
Credential	:
Telephone Number	:	718-585-6188

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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