Provider Demographics
NPI:1730450131
Name:WOODCREST PHARMACY INC.
Entity type:Organization
Organization Name:WOODCREST PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKERJEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-531-9280
Mailing Address - Street 1:59 W 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3509
Mailing Address - Country:US
Mailing Address - Phone:718-293-7320
Mailing Address - Fax:718-293-4135
Practice Address - Street 1:59 W 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3509
Practice Address - Country:US
Practice Address - Phone:718-293-7320
Practice Address - Fax:718-293-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0309753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5804162OtherNCPDP PROVIDER IDENTIFICATION NUMBER