Organization
MID CONCOURSE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIR AHAMED RPH (SUPERVISING PHARM)
(718) 367-4540
Entity
Organization
Contact information
Practice address
2106 GRAND CONCOURSE, BRONX, NY 10457-2800
(718) 367-4540
(718) 563-7369
Mailing address
2106 GRAND CONCOURSE, BRONX, NY 10457-2800
(718) 367-4540
(718) 563-7369
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
018934
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00931113
—
NY
01
—
2064442
PK
—
Enumeration date
09/20/2006
Last updated
02/28/2017
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