=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720429046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATION CARE PHARMACY SOLUTIONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2013
-----------------------------------------------------
Last Update Date | 07/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79 GRAMATAN AVE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-573-5127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 GRAMATAN AVE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-573-5127
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHARLES ETUK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-573-5127
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 032017
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------