Provider Demographics
NPI:1487219440
Name:WILLIS PHARMACY INC
Entity Type:Organization
Organization Name:WILLIS PHARMACY INC
Other - Org Name:BOCA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-7979
Mailing Address - Street 1:514 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4028
Mailing Address - Country:US
Mailing Address - Phone:718-292-7979
Mailing Address - Fax:
Practice Address - Street 1:514 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4028
Practice Address - Country:US
Practice Address - Phone:718-292-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy