Healthcare Provider Details

I. General information

NPI: 1043683550
Provider Name (Legal Business Name): CENTER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 AMSTERDAM AVE
NEW YORK NY
10027-4598
US

IV. Provider business mailing address

1290 AMSTERDAM AVE
NEW YORK NY
10027-4598
US

V. Phone/Fax

Practice location:
  • Phone: 212-222-7922
  • Fax: 212-678-0022
Mailing address:
  • Phone: 212-222-7922
  • Fax: 212-678-0022

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 Number034004
License Number StateNY

VIII. Authorized Official

Name: ELENORA FATTAKHOVA
Title or Position: PRESIDENT
Credential:
Phone: 212-222-7922