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General NPI Number Information
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NPI Number | 1295299535
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Entity Type | Organization
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Legal Business Name | 4TH AVE DRUG STORE INC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 26 S 4TH AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3105
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Country | US
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Telephone | 914-863-0399
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Fax | 914-863-0397
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Provider Business Mailing Address
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Address Line | 26 S 4TH AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-3105
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Country | US
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Telephone | 914-863-0399
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Fax | 914-863-0397
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Authorized Official
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Title or Position | PRESIDENT
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Name | BIBI ESAHACK
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Credential |
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Telephone | 914-863-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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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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