Healthcare Provider Details

I. General information

NPI: 1053638072
Provider Name (Legal Business Name): ANTOINE AMBROISE ESCARMENT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE BASEMENT LOCATION
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-518-5020
  • Fax: 718-716-8736
Mailing address:
  • Phone: 718-518-5020
  • Fax: 718-716-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: