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General NPI Number Information
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NPI Number | 1881922318
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Entity Type | Organization
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Legal Business Name | TARGET PHARMACY
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 2900 VETERANS RD W
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2502
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Country | US
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Telephone | 718-701-6206
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 VETERANS RD W
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2502
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Country | US
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Telephone | 718-701-6206
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | DR. JILL EDELSTEIN
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Credential | PHARM. D
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Telephone | 718-701-6206
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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 | 0541491
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License Number State | NY
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