Healthcare Provider Details

I. General information

NPI: 1518387331
Provider Name (Legal Business Name): PELHAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2014
Last Update Date: 11/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 WHITE PLAINS RD
BRONX NY
10462-1405
US

IV. Provider business mailing address

2171 WHITE PLAINS RD
BRONX NY
10462-1405
US

V. Phone/Fax

Practice location:
  • Phone: 917-708-9700
  • Fax: 917-708-9702
Mailing address:
  • Phone: 917-708-9700
  • Fax: 917-708-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number032726
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032726
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number032726
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number032726
License Number StateNY

VIII. Authorized Official

Name: HOUSSAM NASSER
Title or Position: VICE PRESIDENT
Credential: PHARMD
Phone: 347-419-6737