Organization
PROVISTA SERVICES INC
Active
Other names
Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SALMAN RIAZ (PRES)
(718) 401-3900
Entity
Organization
Contact information
Practice address
2754 3RD AVE, BRONX, NY 10455-4036
(718) 401-3900
(718) 401-3909
Mailing address
2754 3RD AVE, BRONX, NY 10455-4036
(718) 401-3900
(718) 401-3909
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
033795
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153408
PK
—
Enumeration date
07/08/2015
Last updated
02/20/2017
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