Healthcare Provider Details

I. General information

NPI: 1275043200
Provider Name (Legal Business Name): GVM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OLD TOWN RD
STATEN ISLAND NY
10305-1415
US

IV. Provider business mailing address

203 OLD TOWN RD
STATEN ISLAND NY
10305-1415
US

V. Phone/Fax

Practice location:
  • Phone: 718-489-4994
  • Fax: 718-489-4996
Mailing address:
  • Phone: 718-489-4994
  • Fax: 718-489-4996

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: ZAIDY LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 718-489-4994