=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598269383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RED RIBBON PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2018
-----------------------------------------------------
Last Update Date | 03/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2484 ADAM CLAYTON POWELL JR BLVD
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10030-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-901-4699
-----------------------------------------------------
Fax | 646-901-4702
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ALAN CT
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-323-1923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER/OWNER
-----------------------------------------------------
Name | DAVIS SEBASTIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-323-1923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------