Healthcare Provider Details

I. General information

NPI: 1740658426
Provider Name (Legal Business Name): 1150 WEBSTER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 WEBSTER AVENUE
BRONX NY
10456
US

IV. Provider business mailing address

1150 WEBSTER AVENUE
BRONX NY
10456
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-0142
  • Fax:
Mailing address:
  • Phone: 718-975-0142
  • Fax: 347-374-4520

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: RICARDO PEREZ JR.
Title or Position: PRESIDENT
Credential:
Phone: 718-975-0142