Healthcare Provider Details

I. General information

NPI: 1053088567
Provider Name (Legal Business Name): 137 MOTT PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/25/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MOTT ST FRNT A
NEW YORK NY
10013-4718
US

IV. Provider business mailing address

137 MOTT ST FRNT A
NEW YORK NY
10013-4718
US

V. Phone/Fax

Practice location:
  • Phone: 646-669-8220
  • Fax: 646-669-8238
Mailing address:
  • Phone: 646-669-8220
  • Fax: 646-669-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YUEN CHAN
Title or Position: PRESIDENT
Credential: PHARMD.
Phone: 646-669-8220