Provider Demographics
NPI:1710407614
Name:MR M PHARMACY INC
Entity Type:Organization
Organization Name:MR M PHARMACY INC
Other - Org Name:99 CENTS TOP GRADE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLKANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-822-2905
Mailing Address - Street 1:1903 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2705
Mailing Address - Country:US
Mailing Address - Phone:718-822-2905
Mailing Address - Fax:718-822-2924
Practice Address - Street 1:1903 STORY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2705
Practice Address - Country:US
Practice Address - Phone:718-822-2905
Practice Address - Fax:718-822-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X, 333600000X, 3336M0002X, 3336S0011X
NY0356033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170572OtherPK