Healthcare Provider Details

I. General information

NPI: 1598990004
Provider Name (Legal Business Name): DDMH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1588 UNIVERSITY BLVD
BRONX NY
10453-6994
US

IV. Provider business mailing address

1588 UNIVERSITY BLVD
BRONX NY
10453-6994
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-9600
  • Fax: 718-299-9602
Mailing address:
  • Phone: 718-299-9600
  • Fax: 718-299-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029615
License Number StateNY

VIII. Authorized Official

Name: PANKAJ SAINI
Title or Position: TREASURER
Credential:
Phone: 718-299-9600