MEDICARE: BRONX FAMILY PHARMACY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	032530	NY

General Provider Information

NPI Number	:	1154748937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX FAMILY PHARMACY CORP

Provider Business Mailing Address
First Line	:	1800 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1408
Country	:	US
Telephone Number	:	718-828-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1408
Country	:	US
Telephone Number	:	718-828-3450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANSOUR MANSOUR
Credential	:
Telephone Number	:	718-828-3450

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	10/24/2016

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Directions to “BRONX FAMILY PHARMACY CORP ” Practice Location

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