Healthcare Provider Details

I. General information

NPI: 1396068623
Provider Name (Legal Business Name): HMB PHARMACY MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

IV. Provider business mailing address

1515 BLONDELL AVE
BRONX NY
10461-2601
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-9808
  • Fax: 718-239-3523
Mailing address:
  • Phone: 718-239-9808
  • Fax: 718-239-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029873
License Number StateNY

VIII. Authorized Official

Name: RAJ SHAH
Title or Position: COO
Credential:
Phone: 732-318-9628