=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659543817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANHATTANVILLE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2008
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 567 W 125TH ST STORE 2
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-222-3576
-----------------------------------------------------
Fax | 212-222-5172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 WALMSLEY RD
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06820-5130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-940-0507
-----------------------------------------------------
Fax | 203-404-4800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JALAL JAFRI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-940-0507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028829
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------