Healthcare Provider Details

I. General information

NPI: 1740003052
Provider Name (Legal Business Name): REVIVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 OGDEN AVE
BRONX NY
10452-5547
US

IV. Provider business mailing address

917 OGDEN AVE
BRONX NY
10452-5547
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-5190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZIAD GAMAL ABDELNABI
Title or Position: OWNER
Credential:
Phone: 973-449-0091