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NPI Code Detail

MEDICARE: ELDER PHARMACY LLC

MEDICARE: ELDER 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy027511NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12063345OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720020506
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELDER PHARMACY LLC
Provider Business Mailing Address
First Line : 1527 WESTCHESTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10472-2908
Country : US
Telephone Number : 718-842-2777
Fax Number : 718-842-0077
Provider Business Practice Location Address
First Line : 1527 WESTCHESTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10472-2908
Country : US
Telephone Number : 718-842-2777
Fax Number : 718-842-0077
Authorized Official
Title or Position : OWNER, PIC
Name : SANJIV SHETH
Credential : RPH
Telephone Number : 718-842-2777
Provider Enumeration Date : 06/13/2006
Last Update Date : 04/22/2016

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Directions to “ELDER PHARMACY LLC ” Practice Location

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