Healthcare Provider Details

I. General information

NPI: 1700879822
Provider Name (Legal Business Name): K & G PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 JEROME AVE
BRONX NY
10468-6401
US

IV. Provider business mailing address

2434 JEROME AVE
BRONX NY
10468-6401
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-2014
  • Fax: 944-304-2611
Mailing address:
  • Phone: 718-220-2014
  • Fax: 718-220-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number018005
License Number StateNY

VIII. Authorized Official

Name: BIPIN SHETH
Title or Position: OWNER
Credential: RPH
Phone: 718-220-2014