Provider Demographics
NPI:1912004854
Name:BRADHURST PHARMACY INC
Entity Type:Organization
Organization Name:BRADHURST PHARMACY INC
Other - Org Name:BRADHURST PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-345-3838
Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:1ST FLR STE 140A
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1652
Mailing Address - Country:US
Mailing Address - Phone:914-345-3838
Mailing Address - Fax:914-345-3840
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:1ST FLR STE 140A
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1652
Practice Address - Country:US
Practice Address - Phone:914-345-3838
Practice Address - Fax:914-345-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0266063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2533122Medicaid
2062522OtherPK
3337703OtherOTHER ID NUMBER-COMMERCIAL NUMBER