Healthcare Provider Details

I. General information

NPI: 1669877510
Provider Name (Legal Business Name): 99 CENTS TOP GRADE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 STORY AVE
BRONX NY
10473-2705
US

IV. Provider business mailing address

1903 STORY AVE
BRONX NY
10473-2705
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-2905
  • Fax: 718-822-2944
Mailing address:
  • Phone: 718-822-2905
  • Fax: 718-822-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number033027
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number033027
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number033027
License Number StateNY

VIII. Authorized Official

Name: RAFAIE CHOUDHURY
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 718-685-6042