Provider Demographics
NPI:1023498656
Name:BROADWAY RX LLC
Entity type:Organization
Organization Name:BROADWAY RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELKADER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-915-9660
Mailing Address - Street 1:361 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9421
Mailing Address - Country:US
Mailing Address - Phone:718-915-9660
Mailing Address - Fax:718-915-9665
Practice Address - Street 1:361 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9421
Practice Address - Country:US
Practice Address - Phone:718-915-9660
Practice Address - Fax:718-915-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7410740001Medicare NSC