Organization
BRADDOCK PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIPESH SHAH (OWNER)
(718) 347-1516
Entity
Organization
Contact information
Practice address
236-01A BRADDOCK AVE., BELLEROSE, NY 11426
(718) 347-1516
(718) 347-1789
Mailing address
236-01A BRADDOCK AVE., BELLEROSE, NY 11426
(718) 347-1516
(718) 347-1789
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
032318
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497185128
NPI#
NY
Enumeration date
11/17/2015
Last updated
11/17/2015
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