Healthcare Provider Details

I. General information

NPI: 1881087195
Provider Name (Legal Business Name): 184 WELL CARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E 184TH ST
BRONX NY
10468-6502
US

IV. Provider business mailing address

70 E 184TH ST
BRONX NY
10468-6502
US

V. Phone/Fax

Practice location:
  • Phone: 718-329-2000
  • Fax: 718-329-2001
Mailing address:
  • Phone: 718-329-2000
  • Fax: 718-329-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNY

VIII. Authorized Official

Name: SHAMA A MUNIR
Title or Position: PRESITENT
Credential:
Phone: 973-391-3958