Provider Demographics
NPI:1609204346
Name:MOTT HAVEN PHARMACY INC
Entity Type:Organization
Organization Name:MOTT HAVEN PHARMACY INC
Other - Org Name:MOTTHAVEN PHARMACY & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-9144
Mailing Address - Street 1:400 E 141ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2212
Mailing Address - Country:US
Mailing Address - Phone:718-292-9144
Mailing Address - Fax:718-292-9145
Practice Address - Street 1:400 E 141ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2212
Practice Address - Country:US
Practice Address - Phone:718-292-9144
Practice Address - Fax:718-292-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145709OtherPK