=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134167125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLY PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 GRAND ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-226-8971
-----------------------------------------------------
Fax | 212-226-1633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 179 GRAND ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-226-8971
-----------------------------------------------------
Fax | 212-226-1633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISING PHARMACIST
-----------------------------------------------------
Name | MS. LILLY TSIEN
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 212-226-8971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 022843
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------