Provider Demographics
NPI:1639119472
Name:REGAL PHARMACY CORP
Entity Type:Organization
Organization Name:REGAL PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:BSPH
Authorized Official - Phone:718-543-6868
Mailing Address - Street 1:558 W 235TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1709
Mailing Address - Country:US
Mailing Address - Phone:718-543-6868
Mailing Address - Fax:718-543-1957
Practice Address - Street 1:558 W 235TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1709
Practice Address - Country:US
Practice Address - Phone:718-543-6868
Practice Address - Fax:718-543-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00259141Medicaid
NY1639119472Medicare NSC
NY0145100001Medicare ID - Type Unspecified