Healthcare Provider Details

I. General information

NPI: 1548518681
Provider Name (Legal Business Name): CONCORDIA PHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E TREMONT AVE
BRONX NY
10460-4300
US

IV. Provider business mailing address

898 E TREMONT AVE
BRONX NY
10460-4300
US

V. Phone/Fax

Practice location:
  • Phone: 718-328-2833
  • Fax: 718-328-2844
Mailing address:
  • Phone: 718-328-2833
  • Fax: 718-328-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034889
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BHAVESH GAJERA
Title or Position: OWNER
Credential:
Phone: 718-328-2833