Provider Demographics
NPI:1417553850
Name:SAN PEDRO CLAVER PHARMACY INC.
Entity type:Organization
Organization Name:SAN PEDRO CLAVER PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ENIS
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:MEZA-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-510-7985
Mailing Address - Street 1:9115 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2106
Mailing Address - Country:US
Mailing Address - Phone:929-349-1233
Mailing Address - Fax:929-349-1233
Practice Address - Street 1:9115 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2106
Practice Address - Country:US
Practice Address - Phone:929-349-1233
Practice Address - Fax:929-349-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy