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General NPI Number Information
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NPI Number | 1538865019
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Entity Type | Organization
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Legal Business Name | MEDI PRIME PHARMACY INC,
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 10504 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2703
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Country | US
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Telephone | 347-494-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 10504 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FADY GRACE
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Credential |
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Telephone | 347-494-4240
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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 |
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