Healthcare Provider Details

I. General information

NPI: 1417295437
Provider Name (Legal Business Name): NORTH STATE HEALTHY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 PROVOST AVE 1ST FLOOR
BRONX NY
10466-6145
US

IV. Provider business mailing address

3619 PROVOST AVE 1ST FLOOR
BRONX NY
10466-6145
US

V. Phone/Fax

Practice location:
  • Phone: 646-350-0033
  • Fax: 855-326-6768
Mailing address:
  • Phone: 646-350-0033
  • Fax: 855-326-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. FINNY JOSEPH
Title or Position: MEMBER/MANAGER
Credential: RPH
Phone: 919-610-8975