Healthcare Provider Details

I. General information

NPI: 1841518248
Provider Name (Legal Business Name): PRIME AID PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 EAST FORDHAM ROAD
BRONX NY
10458
US

IV. Provider business mailing address

373 EAST FORDHAM ROAD
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-2111
  • Fax: 718-220-2112
Mailing address:
  • Phone: 718-220-2111
  • Fax: 718-220-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030212
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number030212
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number030212
License Number StateNY

VIII. Authorized Official

Name: ALEX FLEYSHUIAKLIER
Title or Position: OWNER
Credential:
Phone: 218-220-2111