Organization
79TH STREET PHARMACY, INC.
Active
Other names
79th Street Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
USMAN TANVIR (PRESIDENT)
(646) 370-5978
Entity
Organization
Contact information
Practice address
215 W 79TH ST, NEW YORK, NY 10024-6242
(646) 370-5978
(646) 398-7680
Mailing address
215 W 79TH ST, NEW YORK, NY 10024-6242
(646) 370-5978
(646) 398-7680
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031405
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138136
PK
—
Enumeration date
10/14/2012
Last updated
09/02/2025
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