Organization
BRAVO SUPER PHARMACY INC
Active
Other names
Bravo Super Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ASIF ALI (PRESIDENT)
(631) 413-6603
Entity
Organization
Contact information
Practice address
174 WHEELER RD, CENTRAL ISLIP, NY 11722-2027
(631) 761-6600
(631) 761-6619
Mailing address
174 WHEELER RD, CENTRAL ISLIP, NY 11722-2027
(631) 761-6600
(631) 761-6619
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
032228
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143520
PK
—
Enumeration date
12/06/2013
Last updated
01/14/2014
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