Provident Pharma LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

030468 Issued in NY

Legal business name

PROVIDENT PHARMA LLC

Doing business as

Morris Ave Pharmacy

Practice address

675 Morris Ave
Bronx, NY 10451-4783

Phone

(718) 292-2500

Fax

(718) 292-2600

NPI assigned

Apr 13, 2015

Last updated

Dec 10, 2015By 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

Mr. Harsh Patel

Title

Owner

Phone

(718) 292-2500

Specialties & licenses 1

Addresses

Other names 1

• Morris Ave Pharmacy Doing business as

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1215323597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514783",
            "telephone_number": "718-292-2500",
            "fax_number": "718-292-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514783",
            "telephone_number": "718-292-2500",
            "fax_number": "718-292-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT PHARMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-13",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "HARSH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-292-2500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Morris Ave Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ivan Jakov Prpic, OD

• Community/Retail Pharmacy in Bronx, NY
• Providers in Bronx, 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 Dec 10, 2015; 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.