Provider Demographics
NPI:1427411776
Name:SOUTH SIDE PHARMACY & HEALTH SHOP LLC
Entity Type:Organization
Organization Name:SOUTH SIDE PHARMACY & HEALTH SHOP LLC
Other - Org Name:SOUTH SIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-782-7200
Mailing Address - Street 1:432 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-6588
Mailing Address - Country:US
Mailing Address - Phone:718-782-7200
Mailing Address - Fax:718-782-7211
Practice Address - Street 1:432 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-6588
Practice Address - Country:US
Practice Address - Phone:718-782-7200
Practice Address - Fax:718-782-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy