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General NPI Number Information
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NPI Number | 1760939490
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Entity Type | Organization
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Legal Business Name | CONGRESS PHARMACY
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Dates
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Enumeration Date | 09/11/2016
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Last Update Date | 09/11/2016
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Provider Practice Location Address
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Address Line | 520 E 9TH ST
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City | BROOKLYN
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State | NY
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Zip | 11218-5208
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Country | US
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Telephone | 347-816-7289
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E 9TH ST
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City | BROOKLYN
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State | NY
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Zip | 11218-5208
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Country | US
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Telephone | 347-816-7289
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Fax |
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Authorized Official
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Title or Position | SP
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Name | KENNY NADELSON
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Credential |
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Telephone | 718-665-6771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 200631
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License Number State | NY
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