Organization
PINEBROOK RX INC
Active
Other names
Pinebrook Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAVIKUMAR MAMIDELA (PRESIDENT)
(718) 992-8182
Entity
Organization
Contact information
Practice address
1183 JEROME AVE, BRONX, NY 10452-3331
(718) 992-8182
(718) 992-8184
Mailing address
1183 JEROME AVE, BRONX, NY 10452-3331
(718) 992-8182
(718) 992-8184
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
031942
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03583382
—
NY
01
—
2140759
PK
—
Enumeration date
03/27/2013
Last updated
10/30/2014
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