Provider Demographics
NPI:1194215392
Name:514 WILLIS AVENUE DRUG CORP
Entity Type:Organization
Organization Name:514 WILLIS AVENUE DRUG CORP
Other - Org Name:BOCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANVIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-7979
Mailing Address - Street 1:514 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:514 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-292-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy