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General NPI Number Information
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NPI Number | 1053698951
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Entity Type | Organization
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Legal Business Name | WEST 142ND STREET PHARMACY CORP
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 3471 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-5628
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Country | US
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Telephone | 212-234-8400
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Fax | 212-234-7700
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Provider Business Mailing Address
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Address Line | 3471 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-5628
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Country | US
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Telephone | 212-234-8400
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Fax | 212-234-7700
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Authorized Official
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Title or Position | MANAGER
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Name | LYUBA MALAKOVA
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Credential |
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Telephone | 917-704-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 030934
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License Number State | NY
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