Provider Demographics
NPI:1437814035
Name:SOUTHERN BOULEVARD PHARMACY INC
Entity Type:Organization
Organization Name:SOUTHERN BOULEVARD PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-877-1190
Mailing Address - Street 1:1767 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4801
Mailing Address - Country:US
Mailing Address - Phone:718-975-0988
Mailing Address - Fax:718-975-0989
Practice Address - Street 1:1767 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4801
Practice Address - Country:US
Practice Address - Phone:718-975-0988
Practice Address - Fax:718-975-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy