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General NPI Number Information
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NPI Number | 1417553850
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Entity Type | Organization
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Legal Business Name | SAN PEDRO CLAVER PHARMACY INC.
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 9115 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2106
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Country | US
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Telephone | 929-349-1233
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Fax | 929-349-1266
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Provider Business Mailing Address
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Address Line | 9115 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2106
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Country | US
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Telephone | 929-349-1233
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Fax | 929-349-1233
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ENIS DE JESUS MEZA-RODRIGUEZ
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Credential | PHARMACIST
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Telephone | 718-510-7985
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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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