# SOUTH BROADWAY PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467770420
- **Authorized official:** MR. TAREK MANSOUR SALEH PHARM D, (SUPERVISING PHARMACIST)
- **Authorized official phone:** (914) 965-1000

## Contact information

- **Practice address:** 314 S BROADWAY, YONKERS, NY 10705-2049
- **Practice address phone:** (914) 965-1000
- **Practice address fax:** (914) 965-1002
- **Mailing address:** 314 S BROADWAY, YONKERS, NY 10705-2049
- **Mailing address phone:** (914) 965-1000
- **Mailing address fax:** (914) 965-1002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 030085 | NY | Yes |

## Other

- **Enumeration date:** 05/13/2010
- **Last updated:** 10/29/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03246077 | — | NY |