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General NPI Number Information
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NPI Number | 1124181854
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Entity Type | Organization
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Legal Business Name | 1699 FANCY PHARMACY INC.
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 05/08/2020
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Provider Practice Location Address
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Address Line | 132 ALLEN ST
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City | NEW YORK
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State | NY
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Zip | 10002-3008
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Country | US
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Telephone | 212-529-4532
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Fax | 212-529-5217
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Provider Business Mailing Address
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Address Line | 132 ALLEN ST
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City | NEW YORK
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State | NY
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Zip | 10002-3008
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Country | US
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Telephone | 212-529-4532
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Fax | 212-529-5217
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. RADIF MUHAMMAD RASHID
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Credential | PHARMD
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Telephone | 212-529-4532
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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 | 019989
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License Number State | NY
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