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General NPI Number Information
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NPI Number | 1992174619
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Entity Type | Organization
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Legal Business Name | BROADWAY REMEDIES CORP.
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 1034 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 516-295-6070
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Fax | 516-295-6071
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Provider Business Mailing Address
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Address Line | 1034 BROADWAY
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City | WOODMERE
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State | NY
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Zip | 11598
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Country | US
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Telephone | 516-295-6070
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Fax | 516-295-6071
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | DR. DEVORAH ROTH
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Credential | PHARMD.
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Telephone | 516-295-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 033842
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License Number State | NY
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