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General NPI Number Information
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NPI Number | 1568002756
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Entity Type | Organization
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Legal Business Name | EDENWALD PHARMACY INC.
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 4137 LACONIA AVE
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City | BRONX
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State | NY
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Zip | 10466
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Country | US
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Telephone | 347-899-8555
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Fax | 347-899-8556
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Provider Business Mailing Address
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Address Line | 4137 LACONIA AVE
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City | BRONX
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State | NY
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Zip | 10466
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Country | US
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Telephone | 347-899-8555
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Fax | 347-899-8556
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Authorized Official
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Title or Position | OWNER
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Name | DULCELINA VELOZ
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Credential | PHARMACY TECH
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Telephone | 347-572-0344
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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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