Provider Demographics
NPI:1154742591
Name:MEDICAL CENTER PHARMACY, INC.
Entity type:Organization
Organization Name:MEDICAL CENTER PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONINO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMENTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-933-3113
Mailing Address - Street 1:571 E 184TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8039
Mailing Address - Country:US
Mailing Address - Phone:718-933-3113
Mailing Address - Fax:718-933-3004
Practice Address - Street 1:571 E 184TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8039
Practice Address - Country:US
Practice Address - Phone:718-933-3113
Practice Address - Fax:718-933-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0323703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143634OtherPK