Provider Demographics
NPI:1033279278
Name:WILLEN PHARMACY INC
Entity Type:Organization
Organization Name:WILLEN PHARMACY INC
Other - Org Name:WILLEN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAZI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAM
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM
Authorized Official - Phone:718-239-7900
Mailing Address - Street 1:3800 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2455
Mailing Address - Country:US
Mailing Address - Phone:718-239-7900
Mailing Address - Fax:718-239-7901
Practice Address - Street 1:3800 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2455
Practice Address - Country:US
Practice Address - Phone:718-239-7900
Practice Address - Fax:718-239-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0187713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00908594Medicaid
2064198OtherPK
2064198OtherPK