Healthcare Provider Details

I. General information

NPI: 1992913537
Provider Name (Legal Business Name): 119 EINSTEIN PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 EINSTEIN LOOP
BRONX NY
10475
US

IV. Provider business mailing address

119 EINSTEIN LOOP
BRONX NY
10475
US

V. Phone/Fax

Practice location:
  • Phone: 718-379-4850
  • Fax: 718-862-0675
Mailing address:
  • Phone: 718-379-4850
  • Fax: 718-862-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028123
License Number StateNY

VIII. Authorized Official

Name: MRS. MERCEDES VARGAS
Title or Position: PRESIDENT
Credential:
Phone: 718-379-4850