Provider Demographics
NPI:1902108111
Name:WEBSTER AVE. PHARMACY CORP.
Entity Type:Organization
Organization Name:WEBSTER AVE. PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:FAROOQ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWAJA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:718-618-0802
Mailing Address - Street 1:1231 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:718-618-0802
Mailing Address - Fax:718-618-0804
Practice Address - Street 1:1231 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3373
Practice Address - Country:US
Practice Address - Phone:718-618-0802
Practice Address - Fax:718-618-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030398333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030398OtherNY STATE BOARD OF PHARMACY