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General NPI Number Information
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NPI Number | 1831845726
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Entity Type | Organization
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Legal Business Name | MAX LIFE PHARMACY INC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 2794 FREDERICK DOUGLASS BLVD
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City | NEW YORK
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State | NY
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Zip | 10039-3012
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Country | US
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Telephone | 646-922-7750
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Fax | 646-922-7748
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Provider Business Mailing Address
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Address Line | 2794 FREDERICK DOUGLASS BLVD
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City | NEW YORK
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State | NY
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Zip | 10039-3012
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Country | US
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Telephone | 646-922-7750
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Fax | 646-922-7748
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Authorized Official
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Title or Position | PHARMACIST IN-CHARGE
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Name | MR. LAURENCE MENSAH
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Credential | RPH
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Telephone | 732-857-5889
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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 |
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License Number State |
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