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General NPI Number Information
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NPI Number | 1457888026
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Entity Type | Organization
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Legal Business Name | 167 LIFE STAR PHARMACY CORP
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1215 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10452-3301
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Country | US
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Telephone | 917-473-7530
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10452-3301
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Country | US
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Telephone | 917-473-7530
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARIA MARTINEZ
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Credential |
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Telephone | 917-724-7701
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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 | NY
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