1366610289 NPI number — ROBERT SUNDER ROBERTS B.S.PHARMACY

Table of content: ROBERT SUNDER ROBERTS B.S.PHARMACY (NPI 1366610289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366610289 NPI number — ROBERT SUNDER ROBERTS B.S.PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
ROBERT
Provider Middle Name:
SUNDER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.S.PHARMACY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1366610289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 9TH AVE
Provider Second Line Business Mailing Address:
GRISTEDES PHARMACY 545
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-4934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-807-0950
Provider Business Mailing Address Fax Number:
212-243-1568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 9TH AVE
Provider Second Line Business Practice Location Address:
GRISTEDES PHARMACY 545
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10011-4934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-807-0950
Provider Business Practice Location Address Fax Number:
212-243-1568
Provider Enumeration Date:
02/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  046100 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: RP447633 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 28RI03573000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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