Bravo Super Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

032228 Issued in NY

Legal business name

BRAVO SUPER PHARMACY INC

Doing business as

Bravo Super Pharmacy Inc

Practice address

174 Wheeler Rd
Central Islip, NY 11722-2027

Phone

(631) 761-6600

Fax

(631) 761-6619

NPI assigned

Dec 6, 2013

Last updated

Jan 14, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Asif Ali

Title

President

Phone

(631) 413-6603

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Bravo Super Pharmacy Inc Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1134550734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 WHEELER RD",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222027",
            "telephone_number": "631-761-6600",
            "fax_number": "631-761-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 WHEELER RD",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117222027",
            "telephone_number": "631-761-6600",
            "fax_number": "631-761-6619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVO SUPER PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "ASIF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-413-6603"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "032228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143520",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bravo Super Pharmacy Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denese Booker, BSN, RN
• Olusegun J Bosede, LPN
• Daphney Bourjolly, DAPHNEY BOURJOLLY
• Angelinna Bradfield
• Lance Bram
• Cornella Renee Brewington-Johnson
• Shelby Brewster
• Shakeisha Bright
• Andre Brown, PN
• Antoinette M Brown

• Community/Retail Pharmacy in Central Islip, NY
• Providers in Central Islip, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.