Healthcare Provider Details

I. General information

NPI: 1689127383
Provider Name (Legal Business Name): VARELA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 ROOSEVELT AVE
WOODSIDE NY
11377-4239
US

IV. Provider business mailing address

5314 ROOSEVELT AVE
WOODSIDE NY
11377-4239
US

V. Phone/Fax

Practice location:
  • Phone: 917-832-6095
  • Fax:
Mailing address:
  • Phone: 917-832-6095
  • Fax: 347-531-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034802
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER FERNANDEZ
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 917-832-6095