=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427425941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 523 PHARMACY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2015
-----------------------------------------------------
Last Update Date | 09/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 MALCOLM X BLVD
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-281-7408
-----------------------------------------------------
Fax | 212-283-4777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 523 MALCOLM X BLVD
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10037-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-281-7408
-----------------------------------------------------
Fax | 212-283-4777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. AMIN CHAUDHRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-281-7408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 033786
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------