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General NPI Number Information
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NPI Number | 1497732515
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Entity Type | Organization
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Legal Business Name | GRISTEDES FOODS INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2109 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 212-787-4076
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Fax | 212-787-4083
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Provider Business Mailing Address
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Address Line | 2109 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 212-787-4076
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Fax | 212-787-4083
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. BARRY SHERMAN
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Credential |
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Telephone | 917-217-2789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 025551
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License Number State | NY
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