Healthcare Provider Details

I. General information

NPI: 1568002756
Provider Name (Legal Business Name): EDENWALD PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 LACONIA AVE
BRONX NY
10466
US

IV. Provider business mailing address

4137 LACONIA AVE
BRONX NY
10466
US

V. Phone/Fax

Practice location:
  • Phone: 347-899-8555
  • Fax: 347-899-8556
Mailing address:
  • Phone: 347-899-8555
  • Fax: 347-899-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DULCELINA VELOZ
Title or Position: OWNER
Credential: PHARMACY TECH
Phone: 347-572-0344