MEDICARE: ECOVERT PHARMA INC.

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
2	3336C0003X	Community/Retail Pharmacy	032160	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2142142	OTHER		PK

General Provider Information

NPI Number	:	1568896173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECOVERT PHARMA INC.

Provider Business Mailing Address
First Line	:	1600 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3994
Country	:	US
Telephone Number	:	212-369-3084
Fax Number	:	212-423-3037

Provider Business Practice Location Address
First Line	:	1600 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3994
Country	:	US
Telephone Number	:	212-369-3084
Fax Number	:	212-423-3037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABOUBACAR SYLLA
Credential	:
Telephone Number	:	212-369-3084

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	12/30/2025

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Directions to “ECOVERT PHARMA INC. ” Practice Location

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