MEDICARE: AMRITA BOSE PHARMD

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	1835P2201X	Ambulatory Care Pharmacist	070983-01	NY

General Provider Information

NPI Number	:	1780433243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMRITA BOSE PHARMD

Provider Business Mailing Address
First Line	:	3168 34TH ST APT A3
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 72ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6143
Country	:	US
Telephone Number	:	844-692-4692
Fax Number	:	646-815-7890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	09/26/2025

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