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General NPI Number Information
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NPI Number | 1700751666
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Entity Type | Organization
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Legal Business Name | ANDEL PHARMACY, LLC
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 219 N 27TH ST STE 9
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City | BOISE
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State | ID
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Zip | 83702-4745
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Country | US
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Telephone | 347-839-8219
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Fax |
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Provider Business Mailing Address
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Address Line | 447 BROADWAY 2ND FLOOR #950
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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 | 347-839-8219
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JAY PHILIP BREGMAN
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Credential |
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Telephone | 347-839-8219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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