Healthcare Provider Details

I. General information

NPI: 1275751687
Provider Name (Legal Business Name): WHARTONS PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 CROSS BAY BLVD
BROAD CHANNEL NY
11693-1125
US

IV. Provider business mailing address

901 CROSS BAY BLVD
BROAD CHANNEL NY
11693-1125
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-3733
  • Fax: 718-634-3377
Mailing address:
  • Phone: 718-634-3733
  • Fax: 718-634-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028217
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLES HOWARD
Title or Position: OWNER
Credential:
Phone: 718-634-3733