Healthcare Provider Details

I. General information

NPI: 1972536456
Provider Name (Legal Business Name): 133RD STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 AMSTERDAM AVE
NEW YORK NY
10027-7472
US

IV. Provider business mailing address

1473 AMSTERDAM AVE
NEW YORK NY
10027-7472
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-4911
  • Fax: 212-491-4916
Mailing address:
  • Phone: 212-491-4911
  • Fax: 212-491-4916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027564
License Number StateNY

VIII. Authorized Official

Name: BHARGAV PATEL
Title or Position: SUP PHARMACIST
Credential: RPH
Phone: 212-491-4911