=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902248701
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLIE PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2013
-----------------------------------------------------
Last Update Date | 06/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2034 2ND AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-598-7028
-----------------------------------------------------
Fax | 646-478-7403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2034 2ND AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-596-7028
-----------------------------------------------------
Fax | 646-478-7403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. AMJID S MUGHAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-634-4473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 032009
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------