Provider First Line Business Practice Location Address:
4996 BROADWAY
Provider Second Line Business Practice Location Address:
ISHAM BROADWAY PHARMACY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10034-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-567-3137
Provider Business Practice Location Address Fax Number:
212-567-3110
Provider Enumeration Date:
03/17/2010