Healthcare Provider Details

I. General information

NPI: 1154792125
Provider Name (Legal Business Name): 145TH ST PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 145TH ST
NEW YORK NY
10039-3142
US

IV. Provider business mailing address

300 W 145TH ST
NEW YORK NY
10039-3142
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-3480
  • Fax:
Mailing address:
  • Phone: 212-281-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAGNIA BALBUENA
Title or Position: PRESIDENT
Credential:
Phone: 917-664-2880