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General NPI Number Information
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NPI Number | 1609942614
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Entity Type | Organization
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Legal Business Name | CASTLETON PHARMACY CORP
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 252 PORT RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1749
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Country | US
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Telephone | 718-720-5600
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Fax | 718-720-5612
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Provider Business Mailing Address
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Address Line | 516 BROADWAY
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2804
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Country | US
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Telephone | 718-720-3710
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Fax | 718-720-6135
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Authorized Official
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Title or Position | PRESIDENT
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Name | BORIS NATENZON
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Credential |
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Telephone | 917-734-4662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 029846
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License Number State | NY
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