Provider Demographics
NPI:1265746416
Name:BURNSIDE PHARMACY CORP
Entity type:Organization
Organization Name:BURNSIDE PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-229-2145
Mailing Address - Street 1:1959 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4505
Mailing Address - Country:US
Mailing Address - Phone:718-824-3745
Mailing Address - Fax:
Practice Address - Street 1:52 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4018
Practice Address - Country:US
Practice Address - Phone:347-820-7989
Practice Address - Fax:347-820-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy