MEDICARE: BRADHURST 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	026606	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2062522	OTHER		PK

General Provider Information

NPI Number	:	1912004854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADHURST PHARMACY INC

Provider Business Mailing Address
First Line	:	95 GRASSLANDS RD
Second Line	:	1ST FLR STE 140A
City	:	VALHALLA
State	:	NY
Zip	:	10595-1652
Country	:	US
Telephone Number	:	914-345-3838
Fax Number	:	914-345-3840

Provider Business Practice Location Address
First Line	:	95 GRASSLANDS RD
Second Line	:	1ST FLR STE 140A
City	:	VALHALLA
State	:	NY
Zip	:	10595-1652
Country	:	US
Telephone Number	:	914-345-3838
Fax Number	:	914-345-3840

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	DEAN ABRAMS
Credential	:
Telephone Number	:	914-345-3838

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/29/2016

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Directions to “BRADHURST PHARMACY INC ” Practice Location

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