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NPI Code Detail

MEDICARE: WEBSTER AVE. PHARMACY CORP.

MEDICARE: WEBSTER AVE. PHARMACY CORP.
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
1333600000XPharmacy030398NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1030398OTHERNYNY STATE BOARD OF PHARMACY

General Provider Information

NPI Number : 1902108111
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEBSTER AVE. PHARMACY CORP.
Provider Business Mailing Address
First Line : 1231 WEBSTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10456
Country : US
Telephone Number : 718-618-0802
Fax Number : 718-618-0804
Provider Business Practice Location Address
First Line : 1231 WEBSTER AVE
Second Line :
City : BRONX
State : NY
Zip : 10456-3373
Country : US
Telephone Number : 718-618-0802
Fax Number : 718-618-0804
Authorized Official
Title or Position : PRES
Name : MR. FAROOQ KHAWAJA
Credential : B.S
Telephone Number : 718-618-0802
Provider Enumeration Date : 11/19/2010
Last Update Date : 11/19/2010

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