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General NPI Number Information
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NPI Number | 1790876365
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Entity Type | Organization
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Legal Business Name | 3817 BROADWAY PHARMACY
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 3835 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1547
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Country | US
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Telephone | 212-927-0220
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Fax | 212-927-8651
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Provider Business Mailing Address
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Address Line | 3835 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1575
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Country | US
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Telephone | 212-927-0220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANICKARAJAN PILLAY
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Credential | RPH
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Telephone | 212-927-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 021013
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License Number State | NY
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