Healthcare Provider Details

I. General information

NPI: 1568588390
Provider Name (Legal Business Name): GCC PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 GRAND CONCOURSE
BRONX NY
10452-6245
US

IV. Provider business mailing address

1575 GRAND CONCOURSE
BRONX NY
10452-6245
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-4800
  • Fax: 718-299-4161
Mailing address:
  • Phone: 718-299-4800
  • Fax: 718-299-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number026401
License Number StateNY

VIII. Authorized Official

Name: RAMILA DESAI
Title or Position: PRESIDENT
Credential:
Phone: 718-299-4800