Provider Demographics
NPI:1457849515
Name:9BURNSIDE INC
Entity Type:Organization
Organization Name:9BURNSIDE INC
Other - Org Name:FARMACIA VIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELVER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-684-4260
Mailing Address - Street 1:9 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4003
Mailing Address - Country:US
Mailing Address - Phone:718-684-4260
Mailing Address - Fax:718-684-4261
Practice Address - Street 1:9 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4003
Practice Address - Country:US
Practice Address - Phone:718-684-4260
Practice Address - Fax:718-684-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy