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General NPI Number Information
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NPI Number | 1174301964
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Entity Type | Organization
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Legal Business Name | MR PHARMACIST LLC
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 3552 E TREMONT AVE # 2
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City | BRONX
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State | NY
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Zip | 10465-2059
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Country | US
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Telephone | 347-293-5741
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Fax | 718-684-4170
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Provider Business Mailing Address
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Address Line | 1731 PAULDING AVE
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City | BRONX
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State | NY
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Zip | 10462-3116
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Country | US
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Telephone | 646-339-0484
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHUONG TRAN
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Credential |
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Telephone | 646-339-0484
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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 |
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License Number State |
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