Provider Demographics
NPI:1629282223
Name:BUENA VISTA PHARMACY
Entity Type:Organization
Organization Name:BUENA VISTA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:RABENOU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:212-369-4018
Mailing Address - Street 1:2022 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2855
Mailing Address - Country:US
Mailing Address - Phone:212-369-4018
Mailing Address - Fax:212-831-8851
Practice Address - Street 1:2022 THIRD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10029-2855
Practice Address - Country:US
Practice Address - Phone:212-369-4018
Practice Address - Fax:212-831-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0124573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy