Healthcare Provider Details

I. General information

NPI: 1881776672
Provider Name (Legal Business Name): GRAND STREET PHARMACEUTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 GRAND ST # 7 G F
NEW YORK NY
10013-4286
US

IV. Provider business mailing address

215 GRAND ST # 7 G F
NEW YORK NY
10013-4286
US

V. Phone/Fax

Practice location:
  • Phone: 212-625-6505
  • Fax: 212-431-4399
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028030
License Number StateNY

VIII. Authorized Official

Name: WILLIAM CHOI
Title or Position: MANAGING MEMBER
Credential:
Phone: 212-925-7698