Provider Demographics
NPI:1578608105
Name:255 COLUMBUS AVE CORP
Entity Type:Organization
Organization Name:255 COLUMBUS AVE CORP
Other - Org Name:WEST SIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESSOH
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:ESSIMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-362-9170
Mailing Address - Street 1:255 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3330
Mailing Address - Country:US
Mailing Address - Phone:212-362-9170
Mailing Address - Fax:212-362-9478
Practice Address - Street 1:255 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3330
Practice Address - Country:US
Practice Address - Phone:212-362-9170
Practice Address - Fax:212-362-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NY0159223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3363734OtherNCPDP PROVIDER IDENTIFICATION NUMBER