Healthcare Provider Details

I. General information

NPI: 1881044501
Provider Name (Legal Business Name): 2070 PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070A JEROME AVE
BRONX NY
10453-1817
US

IV. Provider business mailing address

2070A JEROME AVE
BRONX NY
10453
US

V. Phone/Fax

Practice location:
  • Phone: 347-590-0805
  • Fax: 347-590-0806
Mailing address:
  • Phone: 347-590-0805
  • Fax: 347-590-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034610
License Number StateNY

VIII. Authorized Official

Name: ABEL COLLADO
Title or Position: PRESIDENT
Credential:
Phone: 347-590-0805