MEDICARE: ANTIGUA LOCAL 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1851941959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTIGUA LOCAL PHARMACY LLC

Provider Business Mailing Address
First Line	:	1961 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-1419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-1419
Country	:	US
Telephone Number	:	718-299-0299
Fax Number	:	718-299-2299

Authorized Official
Title or Position	:	MANAGING MEMBER/ SECRETARY
Name	:	BRENDALIS ANTIGUA
Credential	:
Telephone Number	:	347-794-0531

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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Directions to “ANTIGUA LOCAL PHARMACY LLC ” Practice Location

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