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General NPI Number Information
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NPI Number | 1639255599
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Entity Type | Organization
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Legal Business Name | GRAND STREET PHARMACEUTICAL LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 215-7 GRAND ST
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City | NEW YORK
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State | NY
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Zip | 10013
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Country | US
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Telephone | 212-625-9505
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Fax | 212-625-9509
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Provider Business Mailing Address
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Address Line | 215-7 GRAND ST
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City | NEW YORK
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State | NY
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Zip | 10013
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Country | US
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Telephone | 212-625-9505
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Fax | 212-625-9509
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JENNY CEN LIU
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Credential |
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Telephone | 212-625-9505
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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 | 028030
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License Number State | NY
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