| NPI | 1134963291 |
|---|---|
| Former Legal Business Name | SOUTHBRIDGE PHARMACY INC |
| Entity Type | Organization |
| Authorized Contact | VIOLETTA FAZYLOVA President/Pharmacist/Authorized Off 212-786-5840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-26 |