Healthcare Provider Details

I. General information

NPI: 1942221908
Provider Name (Legal Business Name): 5247 BROADWAY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5203A BROADWAY
BRONX NY
10463-7636
US

IV. Provider business mailing address

5203A BROADWAY
BRONX NY
10463-7636
US

V. Phone/Fax

Practice location:
  • Phone: 718-562-6637
  • Fax: 718-562-5031
Mailing address:
  • Phone: 718-562-6637
  • Fax: 718-562-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022921
License Number StateNY

VIII. Authorized Official

Name: ASHOK BARVALIA
Title or Position: PRESIDENT,AO
Credential:
Phone: 718-562-6637