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General NPI Number Information
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NPI Number | 1184848335
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Entity Type | Organization
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Legal Business Name | MERCEDES PHARMACY CORP
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 514 WILLIS AVE
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City | BRONX
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State | NY
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Zip | 10455-4028
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Country | US
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Telephone | 718-292-7979
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Fax | 718-701-0974
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Provider Business Mailing Address
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Address Line | 514 WILLIS AVE
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City | BRONX
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State | NY
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Zip | 10455-4028
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Country | US
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Telephone | 718-292-7979
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Fax | 718-701-0974
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. BRENDA JOHNSON
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Credential |
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Telephone | 718-292-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 037320
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License Number State | NY
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