Provider Demographics
NPI:1265602189
Name:SPECIALTY CARE PHARMACY, INC.
Entity type:Organization
Organization Name:SPECIALTY CARE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONINO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEMENTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:646-206-5855
Mailing Address - Street 1:4463 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2501
Mailing Address - Country:US
Mailing Address - Phone:718-933-9010
Mailing Address - Fax:718-933-9050
Practice Address - Street 1:4463 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2501
Practice Address - Country:US
Practice Address - Phone:718-933-9010
Practice Address - Fax:718-933-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6194950001Medicare NSC