Provider Demographics
NPI:1750688602
Name:MORRIS AVE PHARMACY INC
Entity Type:Organization
Organization Name:MORRIS AVE PHARMACY INC
Other - Org Name:MORRIS AVE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SP
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-292-2500
Mailing Address - Street 1:675 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4783
Mailing Address - Country:US
Mailing Address - Phone:718-292-2500
Mailing Address - Fax:718-292-2600
Practice Address - Street 1:675 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4783
Practice Address - Country:US
Practice Address - Phone:718-292-2500
Practice Address - Fax:718-292-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336M0003X, 3336S0011X
NY0304683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03319835Medicaid
5801926OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03319835Medicaid