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General NPI Number Information
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NPI Number | 1922040716
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Entity Type | Organization
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Legal Business Name | LISCIO PHARMACY CORP
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 2498 WILLIAMSBRIDGE RD
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City | BRONX
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State | NY
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Zip | 10469-4806
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Country | US
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Telephone | 718-547-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 43 BIRCHWOOD LN
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City | HARTSDALE
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State | NY
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Zip | 10530-3124
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Country | US
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Telephone | 914-328-0043
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Fax | 718-231-3919
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Authorized Official
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Title or Position | OWNER
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Name | ALLAN F GROSSO
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Credential |
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Telephone | 718-547-3706
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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 | 008774
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License Number State | NY
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