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Organization
SOUTH BROADWAY PHARMACY
Active
Organization
SOUTH BROADWAY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAREK MANSOUR SALEH PHARM D, (SUPERVISING PHARMACIST)
(914) 965-1000
Entity
Organization
Contact information
Practice address
314 S BROADWAY, YONKERS, NY 10705-2049
(914) 965-1000
(914) 965-1002
Mailing address
314 S BROADWAY, YONKERS, NY 10705-2049
(914) 965-1000
(914) 965-1002
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
030085
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03246077
—
NY
Enumeration date
05/13/2010
Last updated
10/29/2011
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