Provider Demographics
NPI:1114259330
Name:WATER PLACE PHARMACY LLC
Entity Type:Organization
Organization Name:WATER PLACE PHARMACY LLC
Other - Org Name:CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-822-3700
Mailing Address - Street 1:313 E 161ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3535
Mailing Address - Country:US
Mailing Address - Phone:718-822-3700
Mailing Address - Fax:718-822-3711
Practice Address - Street 1:313 E 161ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3535
Practice Address - Country:US
Practice Address - Phone:718-822-3700
Practice Address - Fax:718-822-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0299143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3364546OtherNCPDP
NY029914OtherSTATE BOARD
NY03197293Medicaid
FW 1833905OtherDEA
6414750001Medicare NSC