Healthcare Provider Details

I. General information

NPI: 1770170748
Provider Name (Legal Business Name): NORTH BRONX RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2020
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 WHITE PLAINS RD
BRONX NY
10466-3020
US

IV. Provider business mailing address

4166 WHITE PLAINS RD
BRONX NY
10466-3020
US

V. Phone/Fax

Practice location:
  • Phone: 718-925-4114
  • Fax: 718-925-4112
Mailing address:
  • Phone: 718-925-4114
  • Fax: 718-925-4112

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: SOVEIRA COBOS
Title or Position: MANAGER
Credential:
Phone: 718-925-4114