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General NPI Number Information
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NPI Number | 1053472753
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Entity Type | Organization
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Legal Business Name | BI-WISE PHARMACY CORP.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 26 WEST PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-2018
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Country | US
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Telephone | 516-432-7131
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Fax | 516-432-9347
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Provider Business Mailing Address
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Address Line | 26 WEST PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-2018
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Country | US
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Telephone | 516-432-7131
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Fax | 516-432-9347
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MITCHELL MATZA
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Credential |
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Telephone | 516-432-7131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 028266
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License Number State | NY
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