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General NPI Number Information
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NPI Number | 1023456167
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Entity Type | Organization
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Legal Business Name | RL MT VERNON PHARMACY INC
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 107 W 4TH ST
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City | MOUNT VERNON
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State | NY
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Zip | 10550-4002
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Country | US
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Telephone | 914-699-0235
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Fax | 914-699-3540
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Provider Business Mailing Address
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Address Line | 107 W 4TH ST
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City | MOUNT VERNON
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State | NY
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Zip | 10550-4002
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Country | US
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Telephone | 914-699-0235
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Fax | 914-699-3540
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | WILLIAM EISENMAN
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Credential |
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Telephone | 914-699-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031872
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License Number State | NY
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