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General NPI Number Information
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NPI Number | 1366677395
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Entity Type | Organization
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Legal Business Name | CENTRE STREET PHARMACEUTICAL LLC
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 139 CENTRE ST UNIT 104
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City | NEW YORK
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State | NY
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Zip | 10013-4408
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Country | US
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Telephone | 212-343-1919
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Fax | 212-343-2888
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Provider Business Mailing Address
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Address Line | 139 CENTRE ST UNIT 104
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City | NEW YORK
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State | NY
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Zip | 10013-4408
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Country | US
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Telephone | 212-343-1919
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Fax | 212-343-2888
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. WILLIAM Y CHOI
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Credential | RPH
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Telephone | 973-980-2615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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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