Healthcare Provider Details

I. General information

NPI: 1730617952
Provider Name (Legal Business Name): ULTRACARE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 07/21/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E BROADWAY
NEW YORK NY
10002-6813
US

IV. Provider business mailing address

26 E BROADWAY
NEW YORK NY
10002-6817
US

V. Phone/Fax

Practice location:
  • Phone: 212-941-0888
  • Fax: 212-941-0666
Mailing address:
  • Phone: 212-941-0888
  • Fax: 212-941-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: QING CHEN
Title or Position: PRESIDENT
Credential:
Phone: 212-941-0888