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General NPI Number Information
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NPI Number | 1467599860
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Entity Type | Organization
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Legal Business Name | MELLAU PHARMACY INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 593 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10033-1908
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Country | US
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Telephone | 212-568-5511
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Fax | 855-281-1364
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Provider Business Mailing Address
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Address Line | 593 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10033-1908
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Country | US
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Telephone | 212-923-7176
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Fax | 212-795-8146
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MR. WALTER WILLIAM RYDER
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Credential | PHARMACIST
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Telephone | 212-923-7176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 022914
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License Number State | NY
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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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