1306044557 NPI number — VENUS PHARMACY AND SUPPLIES CORP

Table of content: (NPI 1306044557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306044557 NPI number — VENUS PHARMACY AND SUPPLIES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VENUS PHARMACY AND SUPPLIES CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VENUS PHARMACY AND SUPPLIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306044557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 AMSTERDAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-3002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-666-4800
Provider Business Mailing Address Fax Number:
212-666-1145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
972 AMSTERDAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-666-4800
Provider Business Practice Location Address Fax Number:
212-666-1145
Provider Enumeration Date:
07/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NUNEZ
Authorized Official First Name:
MERCEDES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-666-4800

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028454 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3356967 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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