Healthcare Provider Details

I. General information

NPI: 1932529823
Provider Name (Legal Business Name): YOUR CARE PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2492 WEBSTER AVE
BRONX NY
10458-5509
US

IV. Provider business mailing address

2492 WEBSTER AVE
BRONX NY
10458-5509
US

V. Phone/Fax

Practice location:
  • Phone: 718-502-3070
  • Fax: 718-502-3071
Mailing address:
  • Phone: 718-502-3070
  • Fax: 718-502-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number032724
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number032724
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number032724
License Number StateNY

VIII. Authorized Official

Name: ALEX BLUMIN
Title or Position: OWNER/MANAGER
Credential:
Phone: 718-288-0185