=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457868010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BBRX5
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2018
-----------------------------------------------------
Last Update Date | 01/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 RED SCHOOLHOUSE RD STE G
-----------------------------------------------------
City | CHESTNUT RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977-6736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-352-6165
-----------------------------------------------------
Fax | 845-425-1088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6-G RED SCHOOL HOUSE RD
-----------------------------------------------------
City | CHESTNUT RIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-352-6165
-----------------------------------------------------
Fax | 845-425-1088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM BROWNSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-352-6165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 035991
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------