Healthcare Provider Details

I. General information

NPI: 1609194182
Provider Name (Legal Business Name): TOTALCARE PHARMACY MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 E 194TH ST
BRONX NY
10458-4304
US

IV. Provider business mailing address

322 E 194TH ST
BRONX NY
10458-4304
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-6561
  • Fax: 718-584-6571
Mailing address:
  • Phone: 718-584-6561
  • Fax: 718-584-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030123
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SALIMA DAREDIA
Title or Position: PRESIDENT
Credential:
Phone: 718-584-6561