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NPI Code Detail

MEDICARE: COLUMBUS & 103RD ST DRUG CORP

MEDICARE: COLUMBUS & 103RD ST DRUG 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
13336C0003XCommunity/Retail Pharmacy013409NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23337791OTHERNYNABP

General Provider Information

NPI Number : 1346307311
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLUMBUS & 103RD ST DRUG CORP
Provider Business Mailing Address
First Line : 916 COLUMBUS AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10025-4040
Country : US
Telephone Number : 212-663-7440
Fax Number : 212-663-6074
Provider Business Practice Location Address
First Line : 916 COLUMBUS AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10025-4040
Country : US
Telephone Number : 212-663-7440
Fax Number : 212-663-6074
Authorized Official
Title or Position : PRESIDENT
Name : RUBBAB SEHAR
Credential :
Telephone Number : 201-899-8131
Provider Enumeration Date : 01/02/2007
Last Update Date : 10/25/2022

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Directions to “COLUMBUS & 103RD ST DRUG CORP ” Practice Location

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