Healthcare Provider Details

I. General information

NPI: 1023168341
Provider Name (Legal Business Name): TOTAL HEALTH & BEAUTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4873 BROADWAY
NEW YORK NY
10034-3134
US

IV. Provider business mailing address

4873 BROADWAY
NEW YORK NY
10034-3134
US

V. Phone/Fax

Practice location:
  • Phone: 212-942-8785
  • Fax: 212-942-8791
Mailing address:
  • Phone: 212-942-8785
  • Fax: 212-942-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022920
License Number StateNY

VIII. Authorized Official

Name: STEVEN ROTSTEIN
Title or Position: SUPV PHRM
Credential: RPH
Phone: 212-942-8785