Healthcare Provider Details

I. General information

NPI: 1699573170
Provider Name (Legal Business Name): MRA PATIENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CASTLE HILL AVE
BRONX NY
10472-5463
US

IV. Provider business mailing address

1101 CASTLE HILL AVE
BRONX NY
10472-5463
US

V. Phone/Fax

Practice location:
  • Phone: 718-684-2667
  • Fax: 718-684-2668
Mailing address:
  • Phone: 718-684-2667
  • Fax: 718-684-2668

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: AHMADUR RAZZAQUE
Title or Position: PRESIDENT
Credential:
Phone: 718-684-2667