Healthcare Provider Details

I. General information

NPI: 1821238288
Provider Name (Legal Business Name): MVM PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 138TH ST
BRONX NY
10454-1902
US

IV. Provider business mailing address

800 E 138TH ST
BRONX NY
10454-1902
US

V. Phone/Fax

Practice location:
  • Phone: 718-665-6337
  • Fax: 347-689-1695
Mailing address:
  • Phone: 718-665-6337
  • Fax: 347-689-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number046546-1
License Number StateNY

VIII. Authorized Official

Name: MR. RONALD MOHAMMED
Title or Position: PHARMACIST
Credential: RPH
Phone: 917-548-3349