Organization
SR PHARMACY INC
Active
Other names
BROADWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASA EDAVALAPATI (PHARMACY MANAGER)
(212) 740-8500
Entity
Organization
Contact information
Practice address
4329 BROADWAY, NEW YORK, NY 10033-2408
(212) 740-8500
(212) 740-9400
Mailing address
4329 BROADWAY, NEW YORK, NY 10033-2408
(212) 740-8500
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
027473
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2066379
PK
—
05
—
2721093
—
NY
Enumeration date
06/09/2006
Last updated
01/17/2017
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