Healthcare Provider Details

I. General information

NPI: 1386354546
Provider Name (Legal Business Name): 180 PHARMA CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 BAY RIDGE AVE APT 02A
BROOKLYN NY
11220
US

IV. Provider business mailing address

268 BAY RIDGE AVE APT 02A
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 347-203-9612
  • Fax:
Mailing address:
  • Phone: 347-203-9612
  • Fax:

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: MOHAMED TAGELDIN
Title or Position: PRESIDENT
Credential:
Phone: 347-509-4420