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General NPI Number Information
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NPI Number | 1760961262
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Entity Type | Organization
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Legal Business Name | DETRONET.COM LLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 2632 ADAM CLAYTON POWELL JR BLVD
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City | NEW YORK
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State | NY
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Zip | 10039-2601
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Country | US
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Telephone | 646-850-1932
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Fax | 646-931-1951
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Provider Business Mailing Address
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Address Line | 2632 ADAM CLAYTON POWELL JR BLVD
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City | NEW YORK
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State | NY
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Zip | 10039-2601
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Country | US
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Telephone | 917-409-3219
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Fax | 917-409-3179
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | SALAH K ISMAIL
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Credential | PHARMACIST
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Telephone | 347-792-1545
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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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Taxonomy #2
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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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