Healthcare Provider Details

I. General information

NPI: 1871921353
Provider Name (Legal Business Name): TEBA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 5TH AVE
BROOKLYN NY
11209-3304
US

IV. Provider business mailing address

7618 5TH AVE
BROOKLYN NY
11209-3304
US

V. Phone/Fax

Practice location:
  • Phone: 347-517-4833
  • Fax: 347-517-4834
Mailing address:
  • Phone: 347-517-4833
  • Fax: 347-517-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032292
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ISSAM SALAMEH
Title or Position: CEO
Credential:
Phone: 646-717-4600