Healthcare Provider Details

I. General information

NPI: 1699002352
Provider Name (Legal Business Name): KHELLY (NY) INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 E GUNHILL RD
BRONX NY
10467
US

IV. Provider business mailing address

83 E GUNHILL RD
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 718-654-4305
  • Fax: 718-654-4506
Mailing address:
  • Phone: 718-654-4305
  • Fax: 718-654-4506

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: MRS. MINA R SHAH
Title or Position: PRESIDENT
Credential:
Phone: 732-318-9628