Provider Demographics
NPI:1518074988
Name:BOWERY PHARMACY INC
Entity Type:Organization
Organization Name:BOWERY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-219-0449
Mailing Address - Street 1:95 BOWERY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4901
Mailing Address - Country:US
Mailing Address - Phone:212-219-0449
Mailing Address - Fax:212-219-0580
Practice Address - Street 1:95 BOWERY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4901
Practice Address - Country:US
Practice Address - Phone:212-219-0449
Practice Address - Fax:212-219-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3382823OtherNABP
NY00886686Medicaid
3382823OtherNABP