Healthcare Provider Details

I. General information

NPI: 1134213549
Provider Name (Legal Business Name): OVAL PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 METROPOLITAN AVE
BRONX NY
10462-6801
US

IV. Provider business mailing address

1500 METROPOLITAN AVE
BRONX NY
10462-6801
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-0688
  • Fax: 718-823-1149
Mailing address:
  • Phone: 718-823-0688
  • Fax: 718-823-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number033722
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAYSHREE DESAI
Title or Position: PRESIDENT
Credential:
Phone: 718-823-0688