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4th Ave Drug Store INC

Pharmacy, Community/Retail Pharmacy in Mount Vernon, NY. Organization (NPI-2).

NPI number1295299535
StatusActive
Last updated in NPPESJun 8, 2020

Details

NPI
1295299535
Entity type
Organization (NPI-2)
Legal business name
4th Ave Drug Store INC
Organization subpart
No
Enumeration date
Jan 30, 2019
Certification date
Jun 8, 2020
Last updated
Jun 8, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3336C0003X Pharmacy, Community/Retail Pharmacy––Yes
333600000X Pharmacy––

Practice location

26 S 4th Ave
Mount Vernon, NY 10550-3105

Phone 914-863-0399 · Fax 914-863-0397

Mailing address

26 S 4th Ave
Mount Vernon, NY 10550-3105

Phone 914-863-0399 · Fax 914-863-0397

Authorized official

Bibi Esahack
President
9148630399

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