1316934342 NPI number — CONCOURSE DRUGS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316934342 NPI number — CONCOURSE DRUGS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCOURSE DRUGS INC.
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:
Provider Other Organization Name Type Code:
6
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:
1316934342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3137 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10468-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-733-8528
Provider Business Mailing Address Fax Number:
718-733-8529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3137 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-733-8528
Provider Business Practice Location Address Fax Number:
718-733-8529
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KARIM
Authorized Official First Name:
IQBAL
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
718-733-8528

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  024368 , 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: 01928707 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024368 . This is a "PHARMACY LICENCE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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