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General NPI Number Information
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NPI Number | 1114259330
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Entity Type | Organization
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Legal Business Name | WATER PLACE PHARMACY LLC
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Dates
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Enumeration Date | 02/13/2010
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 313 E 161ST ST
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City | BRONX
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State | NY
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Zip | 10451-3535
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Country | US
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Telephone | 718-822-3700
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Fax | 718-822-3711
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Provider Business Mailing Address
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Address Line | 313 E 161ST ST
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City | BRONX
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State | NY
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Zip | 10451-3535
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Country | US
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Telephone | 718-822-3700
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Fax | 718-822-3711
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | NEIL SUBES
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Credential |
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Telephone | 718-822-3700
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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 | 029914
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License Number State | NY
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