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General NPI Number Information
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NPI Number | 1740465814
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Entity Type | Organization
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Legal Business Name | BRADHURST SPECIALTY PHARMACY INC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 19 BRADHURST AVE SUITE L1
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City | HAWTHORNE
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State | NY
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Zip | 10532-2140
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Country | US
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Telephone | 914-345-0070
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Fax | 914-345-0211
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Provider Business Mailing Address
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Address Line | 10050 CROSSTOWN CIR SUITE 300
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3348
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Country | US
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Telephone | 952-979-3680
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Fax | 952-352-6698
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JAMES MELANCON
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Credential |
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Telephone | 917-449-6939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 028582
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License Number State | NY
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