Provider Demographics
NPI:1477650307
Name:872 HPA DRUG CORP
Entity Type:Organization
Organization Name:872 HPA DRUG CORP
Other - Org Name:BOCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:YARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-971-9391
Mailing Address - Street 1:PO BOX 740054
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-0001
Mailing Address - Country:US
Mailing Address - Phone:718-292-2088
Mailing Address - Fax:718-292-4884
Practice Address - Street 1:736 E 152ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2203
Practice Address - Country:US
Practice Address - Phone:718-292-2088
Practice Address - Fax:718-929-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0295303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2063665OtherPK
NY02207023Medicaid
NY02207023Medicaid