Organization
NILE RIDGE PHARMA CORP.
Active
Other names
NILE RIDGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. YASER MANSOUR (AUTHORIZED OFFICIAL)
(718) 333-5746
Entity
Organization
Contact information
Practice address
6922 4TH AVE, BROOKLYN, NY 11209-1502
(718) 219-1827
(347) 825-2350
Mailing address
6922 4TH AVE, BROOKLYN, NY 11209-1502
(718) 333-5746
(718) 333-5749
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NY
Enumeration date
06/02/2019
Last updated
07/02/2024
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