Organization
75 BURNSIDE DRUG AND SURGICAL INC
Active
Other names
BURNSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
VARGHESE ABRAHAM B.PHARM (SUPERVISING PHARMACIST)
(718) 731-8505
Entity
Organization
Contact information
Practice address
75 W BURNSIDE AVE, BRONX, NY 10453-4015
(718) 731-8505
(718) 731-8127
Mailing address
75 W BURNSIDE AVE, BRONX, NY 10453-4015
(718) 731-8505
(718) 731-8127
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
024771
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02082915
—
NY
01
—
2061635
PK
—
Enumeration date
02/06/2007
Last updated
04/05/2020
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