Healthcare Provider Details

I. General information

NPI: 1902342538
Provider Name (Legal Business Name): DENISON RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E TREMONT AVE STORE H
BRONX NY
10460-4108
US

IV. Provider business mailing address

815 E TREMONT AVE STORE H
BRONX NY
10460-4108
US

V. Phone/Fax

Practice location:
  • Phone: 718-513-3210
  • Fax: 718-513-3209
Mailing address:
  • Phone: 718-513-3210
  • Fax: 718-513-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number035099
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAVLE GRDZELISHVILI
Title or Position: PRESIDENT
Credential:
Phone: 718-513-3210