Healthcare Provider Details

I. General information

NPI: 1457369548
Provider Name (Legal Business Name): BLISS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 MADISON AVE C/O BLISS PHARMACY INC.
NEW YORK NY
10029-3816
US

IV. Provider business mailing address

1590 MADISON AVE C/O BLISS PHARMACY INC.
NEW YORK NY
10029-3816
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-4382
  • Fax: 212-427-9019
Mailing address:
  • Phone: 212-427-4382
  • Fax: 212-427-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number018424
License Number StateNY

VIII. Authorized Official

Name: MOHAMMAD MOHSIN QADIR
Title or Position: PHARMACIST
Credential: R.PH
Phone: 212-427-4382