=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477029601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEGEND DRUGS 1 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2018
-----------------------------------------------------
Last Update Date | 12/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 E GUN HILL RD
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-708-7427
-----------------------------------------------------
Fax | 718-708-5108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 E GUN HILL RD
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-708-7427
-----------------------------------------------------
Fax | 718-708-5108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | VANDANA PAREKH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-218-4063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------