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General NPI Number Information
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NPI Number | 1508855990
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Entity Type | Organization
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Legal Business Name | ETBA PHARMACY INC.
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 530 E 138TH ST
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City | BRONX
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State | NY
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Zip | 10454-4906
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Country | US
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Telephone | 718-665-2018
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Fax | 718-665-3575
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Provider Business Mailing Address
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Address Line | 530 E 138TH ST
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City | BRONX
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State | NY
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Zip | 10454-4906
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Country | US
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Telephone | 718-665-2018
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Fax | 718-665-3575
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Authorized Official
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Title or Position | PHARMACIST/MANAGER
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Name | MRS. KAMALA IYER
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Credential | PHARMACIST
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Telephone | 718-665-2018
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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 | 027244
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License Number State | NY
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