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NPI Code Detail

MEDICARE: NYPRES PHARMACY INC

MEDICARE: NYPRES PHARMACY 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy034238NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12158022OTHERPK

General Provider Information

NPI Number : 1619335593
Entity Type Code : Organization
Provider Name (Legal Business Name) : NYPRES PHARMACY INC
Provider Business Mailing Address
First Line : 1083 SAINT NICHOLAS AVE
Second Line : STO # 2
City : NEW YORK
State : NY
Zip : 10032-3829
Country : US
Telephone Number : 646-918-6640
Fax Number : 646-918-6803
Provider Business Practice Location Address
First Line : 1083 SAINT NICHOLAS AVE
Second Line : STO # 2
City : NEW YORK
State : NY
Zip : 10032-3829
Country : US
Telephone Number : 646-918-6640
Fax Number : 646-918-6803
Authorized Official
Title or Position : PRESIDENT
Name : DIANA GRULLON
Credential :
Telephone Number : 201-294-9765
Provider Enumeration Date : 02/05/2016
Last Update Date : 09/22/2016

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