Healthcare Provider Details

I. General information

NPI: 1609942614
Provider Name (Legal Business Name): CASTLETON PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1749
US

IV. Provider business mailing address

516 BROADWAY
STATEN ISLAND NY
10310-2804
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-5600
  • Fax: 718-720-5612
Mailing address:
  • Phone: 718-720-3710
  • Fax: 718-720-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029846
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BORIS NATENZON
Title or Position: PRESIDENT
Credential:
Phone: 917-734-4662