Organization
66 NAGLE AVENUE CORP
Active
Other names
THERESA PHARMACY II
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT NEWMAN (PHARMACIST/VP)
(212) 304-3949
Entity
Organization
Contact information
Practice address
66 NAGLE AVE, NEW YORK, NY 10040-1406
(212) 304-3949
(212) 304-4339
Mailing address
66 NAGLE AVE, NEW YORK, NY 10040-1406
(212) 304-3949
(212) 304-4339
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
022529
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01584358
—
NY
01
—
3302712
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/23/2005
Last updated
04/19/2010
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