Healthcare Provider Details

I. General information

NPI: 1710407614
Provider Name (Legal Business Name): MR M PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 STORY AVE
BRONX NY
10473-2705
US

IV. Provider business mailing address

1903 STORY AVE
BRONX NY
10473-2705
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-2905
  • Fax: 718-822-2924
Mailing address:
  • Phone: 718-822-2905
  • Fax: 718-822-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
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 Number035603
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOSHE MOLKANDOW
Title or Position: PRESIDENT
Credential:
Phone: 718-822-2905