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General NPI Number Information
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NPI Number | 1699946707
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Entity Type | Organization
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Legal Business Name | POLISE BROTHERS ENTERPRISE INC.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 2392 21ST ST
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City | ASTORIA
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State | NY
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Zip | 11105
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Country | US
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Telephone | 718-728-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 22-53 CRESCENT STREET
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City | ASTORIA
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State | NY
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Zip | 11105
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Country | US
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Telephone | 718-728-3300
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | DR. MICHAEL ARCANGELO POLISE
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Credential | PHARMD
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Telephone | 917-496-4013
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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 |
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License Number State |
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