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General NPI Number Information
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NPI Number | 1184138885
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Entity Type | Organization
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Legal Business Name | B&T PORT RICHMOND PHARMACY INC.
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 251 PORT RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1704
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Country | US
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Telephone | 718-720-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 251 PORT RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1704
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Country | US
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Telephone | 718-720-1111
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Fax |
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | MR. ANATOLY GOROKHOVSKY
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Credential |
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Telephone | 718-720-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 035842
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License Number State | NY
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