Healthcare Provider Details

I. General information

NPI: 1285072546
Provider Name (Legal Business Name): 137 PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W 137TH ST
NEW YORK NY
10037-1900
US

IV. Provider business mailing address

3 W 137TH ST
NEW YORK NY
10037-1900
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-4881
  • Fax: 212-281-4882
Mailing address:
  • Phone: 212-281-4881
  • Fax: 212-281-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031858
License Number StateNY

VIII. Authorized Official

Name: TODD WISEBERG
Title or Position: PRESIDENT
Credential:
Phone: 212-281-4881