Healthcare Provider Details

I. General information

NPI: 1518291087
Provider Name (Legal Business Name): CHIDIEBERE BETRAN ABALLA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 EAST . TREMONT AVE. BEST AID PHARMACY
BRONX NY
10450
US

IV. Provider business mailing address

563 EAST TREMONT AVE. BEST AID PHARMACY
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 718-466-4700
  • Fax:
Mailing address:
  • Phone: 718-466-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number052538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: