Healthcare Provider Details

I. General information

NPI: 1760149975
Provider Name (Legal Business Name): 31ST & 3RD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST STE 5-013
NEW YORK NY
10018-2913
US

IV. Provider business mailing address

10604 COURSEY BLVD
BATON ROUGE LA
70816-4015
US

V. Phone/Fax

Practice location:
  • Phone: 212-380-1840
  • Fax:
Mailing address:
  • Phone: 225-236-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RYAN BOYLE
Title or Position: REGULATORY COUNSEL
Credential:
Phone: 225-236-1538