Healthcare Provider Details

I. General information

NPI: 1134543671
Provider Name (Legal Business Name): EXPRESS CARE PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E TREMONT AVE
BRONX NY
10453-5801
US

IV. Provider business mailing address

15 E TREMONT AVE
BRONX NY
10453-5801
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-7525
  • Fax: 718-618-7526
Mailing address:
  • Phone: 718-618-7525
  • Fax: 718-618-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032466
License Number StateNY

VIII. Authorized Official

Name: MISS ELSA SIMO
Title or Position: PRESIDENT
Credential:
Phone: 718-618-7525