=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609122605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORUM DRUGS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2012
-----------------------------------------------------
Last Update Date | 07/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 W 127TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-222-7766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 W 127TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-222-7766
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAGRUT SHROFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-222-7766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 031259
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------