Healthcare Provider Details

I. General information

NPI: 1104159979
Provider Name (Legal Business Name): TRUPTISUDHIR PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 WHITE PLAINS RD
BRONX NY
10467-8129
US

IV. Provider business mailing address

2901 WHITE PLAINS RD
BRONX NY
10467-8129
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-7958
  • Fax: 347-824-2002
Mailing address:
  • Phone: 718-881-7958
  • Fax: 347-824-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029894
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUDHIR PATEL
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 718-881-7958