Healthcare Provider Details

I. General information

NPI: 1700271897
Provider Name (Legal Business Name): PHARMACENA LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MINEOLA AVE
CARLE PLACE NY
11514-1716
US

IV. Provider business mailing address

516 MINEOLA AVE
CARLE PLACE NY
11514-1716
US

V. Phone/Fax

Practice location:
  • Phone: 516-209-4970
  • Fax: 888-315-7741
Mailing address:
  • Phone: 516-209-4970
  • Fax: 888-315-7741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number033465
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADIL PALWALA
Title or Position: PRESIDENT
Credential:
Phone: 888-315-7740