Organization
SECOND AVE PHARMACY INC
Active
Other names
SECOND AVE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATA DONDAPATI RPH (PARTNER AND SUPERVISING PHCST)
(212) 876-8300
Entity
Organization
Contact information
Practice address
249 E 115TH ST, NEW YORK, NY 10029-2130
(212) 876-8300
(212) 876-5280
Mailing address
249 E 115TH ST, NEW YORK, NY 10029-2130
(212) 876-8300
(212) 876-5280
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
026821
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02590632
—
NY
01
—
2062983
PK
—
Enumeration date
10/20/2006
Last updated
07/07/2016
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