Willis Ave Drugs Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

035797 Issued in NY

Legal business name

WILLIS AVE DRUGS INC

Practice address

208 Willis Ave
Bronx, NY 10454-4844

Phone

(718) 585-5300

Fax

(718) 585-1213

NPI assigned

Sep 29, 2017

Organization subpart

No

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

Authorized official

Name

Samina Nadeem

Title

President

Phone

(718) 585-5300

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Willis Pharmacy Other name

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1720597008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 WILLIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104544844",
            "telephone_number": "718-585-5300",
            "fax_number": "718-585-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 WILLIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104544844",
            "telephone_number": "718-585-5300",
            "fax_number": "718-585-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS AVE DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "NADEEM",
        "authorized_official_first_name": "SAMINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-585-5300"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "035797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04889089",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2171836",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willis Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kenisha Janice Williamson
• Michelle Williamson
• Shauna Williamson
• Chanae Paris Willingham, RN
• Willis 146 Pharmacy Inc (BZ Pharmacy)
• Willis Care Pharmacy Inc (Willis pharmacy)
• Willis Dental Care, P.L.L.C.
• Willis Star Pharmacy Inc. (Willis Pharmacy)
• Aaliyah Willis, LMSW
• Adrienne Christina Willis, LMT

• 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 Apr 19, 2018; 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.