Provider Demographics
NPI:1497946669
Name:ALLERTON CORP
Entity Type:Organization
Organization Name:ALLERTON CORP
Other - Org Name:BRONX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HMZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-466-5500
Mailing Address - Street 1:1320 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7971
Mailing Address - Country:US
Mailing Address - Phone:718-466-5500
Mailing Address - Fax:718-466-5505
Practice Address - Street 1:1320 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-7971
Practice Address - Country:US
Practice Address - Phone:718-466-5500
Practice Address - Fax:718-466-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02902885Medicaid
NY1023151859Medicaid