Healthcare Provider Details

I. General information

NPI: 1700253713
Provider Name (Legal Business Name): BHOLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 BROADWAY
NEW YORK NY
10031-1502
US

IV. Provider business mailing address

3663 BROADWAY
NEW YORK NY
10031-1502
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-2910
  • Fax: 212-491-9996
Mailing address:
  • Phone: 212-491-2910
  • Fax: 212-491-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034130
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ASHISH SEVAK
Title or Position: R.PH.
Credential:
Phone: 212-491-2910