Organization
GRAND CONCOURSE PHARMACY INC
Active
Other names
Grand Concourse Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD SHABBIR (PRESIDENT)
(718) 901-3186
Entity
Organization
Contact information
Practice address
233 E TREMONT AVE, BRONX, NY 10457-5303
(718) 901-3186
Mailing address
233 E TREMONT AVE, BRONX, NY 10457-5303
(718) 901-3186
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030089
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3236564
—
NY
01
—
5800176
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/10/2010
Last updated
03/28/2012
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