Provider Demographics
NPI:1619335593
Name:NYPRES PHARMACY INC
Entity Type:Organization
Organization Name:NYPRES PHARMACY INC
Other - Org Name:NYPRES PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRULLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-294-9765
Mailing Address - Street 1:1083 SAINT NICHOLAS AVE
Mailing Address - Street 2:STO # 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3829
Mailing Address - Country:US
Mailing Address - Phone:646-918-6640
Mailing Address - Fax:646-918-6803
Practice Address - Street 1:1083 SAINT NICHOLAS AVE
Practice Address - Street 2:STO # 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3829
Practice Address - Country:US
Practice Address - Phone:646-918-6640
Practice Address - Fax:646-918-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0342383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158022OtherPK