Organization
PROVISTA SERVICES INC
Active
Other names
FAMILY SPECIALITY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. 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
3336C0003X
Community/Retail Pharmacy
Primary
028951
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3358365
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/27/2008
Last updated
06/16/2015
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