MEDICARE: BHOLE 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
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	034130	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2162507	OTHER		PK

General Provider Information

NPI Number	:	1700253713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHOLE PHARMACY INC

Provider Business Mailing Address
First Line	:	3663 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1502
Country	:	US
Telephone Number	:	212-491-2910
Fax Number	:	212-491-9996

Provider Business Practice Location Address
First Line	:	3663 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1502
Country	:	US
Telephone Number	:	212-491-2910
Fax Number	:	212-491-9996

Authorized Official
Title or Position	:	R.PH.
Name	:	ASHISH SEVAK
Credential	:
Telephone Number	:	212-491-2910

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	08/15/2016

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Directions to “BHOLE PHARMACY INC ” Practice Location

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