Healthcare Provider Details

I. General information

NPI: 1922348218
Provider Name (Legal Business Name): 184TH ST PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 E 184TH ST
BRONX NY
10468-6501
US

IV. Provider business mailing address

69 E 184TH ST
BRONX NY
10468-6501
US

V. Phone/Fax

Practice location:
  • Phone: 347-787-5434
  • Fax: 347-787-5435
Mailing address:
  • Phone: 347-787-5434
  • Fax: 347-787-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031663
License Number StateNY

VIII. Authorized Official

Name: TAREK ELSAYED
Title or Position: OWNER
Credential:
Phone: 347-787-5434