Healthcare Provider Details

I. General information

NPI: 1457849515
Provider Name (Legal Business Name): 9BURNSIDE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W BURNSIDE AVE
BRONX NY
10453-4003
US

IV. Provider business mailing address

9 W BURNSIDE AVE
BRONX NY
10453-4003
US

V. Phone/Fax

Practice location:
  • Phone: 718-684-4260
  • Fax: 718-684-4261
Mailing address:
  • Phone: 718-684-4260
  • Fax: 718-684-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELVER PARRA
Title or Position: PRESIDENT
Credential:
Phone: 718-684-4260