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General NPI Number Information
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NPI Number | 1629282223
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Entity Type | Organization
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Legal Business Name | BUENA VISTA PHARMACY
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2022 THIRD AVE
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City | NEW YORK CITY
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State | NY
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Zip | 10029-2855
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Country | US
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Telephone | 212-369-4018
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Fax | 212-831-8851
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Provider Business Mailing Address
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Address Line | 2022 THIRD AVE
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City | NEW YORK CITY
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State | NY
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Zip | 10029-2855
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Country | US
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Telephone | 212-369-4018
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Fax | 212-831-8851
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. DAVID C RABENOU
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Credential | PHARMACIST
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Telephone | 212-369-4018
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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 | 012457
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License Number State | NY
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