=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962736868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENBURGH PHARMACY CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2009
-----------------------------------------------------
Last Update Date | 12/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 E 149TH ST
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10455-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-590-0831
-----------------------------------------------------
Fax | 347-590-0833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 430 E 149TH ST
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10455-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-590-0831
-----------------------------------------------------
Fax | 347-590-0833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. NOUR PHILIP ANNABI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-484-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------