Organization
4TH AVE DRUG STORE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIBI ESAHACK (PRESIDENT)
(914) 863-0399
Entity
Organization
Contact information
Practice address
26 S 4TH AVE, MOUNT VERNON, NY 10550-3105
(914) 863-0399
(914) 863-0397
Mailing address
26 S 4TH AVE, MOUNT VERNON, NY 10550-3105
(914) 863-0399
(914) 863-0397
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
01/30/2019
Last updated
06/08/2020
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