Provider Demographics
NPI:1427573468
Name:BRONX WELLNESS PHARMACY INC
Entity Type:Organization
Organization Name:BRONX WELLNESS PHARMACY INC
Other - Org Name:BRONX WELLNESS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMANKWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-708-7996
Mailing Address - Street 1:3007 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455
Mailing Address - Country:US
Mailing Address - Phone:718-708-7996
Mailing Address - Fax:718-708-7997
Practice Address - Street 1:3007 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1200
Practice Address - Country:US
Practice Address - Phone:718-708-7996
Practice Address - Fax:718-708-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0357723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170908OtherPK