Healthcare Provider Details

I. General information

NPI: 1912038019
Provider Name (Legal Business Name): REDI CORPORATION AND PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 RONALD REAGAN BLVD
WARWICK NY
10990-4118
US

IV. Provider business mailing address

44 RONALD REAGAN BLVD
WARWICK NY
10990-4118
US

V. Phone/Fax

Practice location:
  • Phone: 845-988-5805
  • Fax: 914-988-5872
Mailing address:
  • Phone: 845-988-5805
  • Fax: 914-988-5872

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 Number024507
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARKADY CHEPKUUOV
Title or Position: OWNER
Credential:
Phone: 845-988-5805