MEDICARE: HUDSON PHARMACY

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	28RS00709700	NJ

General Provider Information

NPI Number	:	1871897868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON PHARMACY

Provider Business Mailing Address
First Line	:	5313 HUDSON AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5313 HUDSON AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2045
Country	:	US
Telephone Number	:	917-348-6208
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. AZEEM EDWIN SHEIKH
Credential	:	PHARM.D
Telephone Number	:	917-348-6208

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/12/2011

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