Provider Demographics
NPI:1053088567
Name:137 MOTT PHARMACY, INC.
Entity Type:Organization
Organization Name:137 MOTT PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:646-669-8220
Mailing Address - Street 1:137 MOTT ST FRNT A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4718
Mailing Address - Country:US
Mailing Address - Phone:646-669-8220
Mailing Address - Fax:646-669-8238
Practice Address - Street 1:137 MOTT ST FRNT A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4718
Practice Address - Country:US
Practice Address - Phone:646-669-8220
Practice Address - Fax:646-669-8238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy