Provider Demographics
NPI:1275751687
Name:WHARTONS PHARMACY CORP
Entity Type:Organization
Organization Name:WHARTONS PHARMACY CORP
Other - Org Name:WHARTON'S APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-634-3733
Mailing Address - Street 1:901 CROSS BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROAD CHANNEL
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1125
Mailing Address - Country:US
Mailing Address - Phone:718-634-3733
Mailing Address - Fax:718-634-3377
Practice Address - Street 1:901 CROSS BAY BLVD
Practice Address - Street 2:
Practice Address - City:BROAD CHANNEL
Practice Address - State:NY
Practice Address - Zip Code:11693-1125
Practice Address - Country:US
Practice Address - Phone:718-634-3733
Practice Address - Fax:718-634-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0282173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02890164Medicaid
NY5909310001Medicare NSC