Healthcare Provider Details

I. General information

NPI: 1346226891
Provider Name (Legal Business Name): MIDRAG NINE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 TARRYTOWN ROAD
WHITE PLAINS NY
10607
US

IV. Provider business mailing address

417 TARRYTOWN RD
WHITE PLAINS NY
10607-1423
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-4141
  • Fax: 914-948-7559
Mailing address:
  • Phone: 914-948-4141
  • Fax: 914-948-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number023767
License Number StateNY

VIII. Authorized Official

Name: MR. LAURENCE MIRESSI
Title or Position: PRESIDENT
Credential:
Phone: 914-948-4141