Riverdale Healthy Life Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

034827 Issued in NY

Legal business name

RIVERDALE HEALTHY LIFE INC

Doing business as

Tri-Road Pharmacy

Practice address

791 Westchester Ave
Bronx, NY 10455-1722

Phone

(917) 570-5169

Fax

(718) 483-9522

NPI assigned

Jan 10, 2017

Organization subpart

No

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

Authorized official

Name

Michael HaddadNPI 1942483177

Title

Owner

Phone

(917) 570-5169

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tri-Road Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Haddad, RPH

  • Pharmacist
  • Bronx, NY
  • NPI 1942483177
  NPD Authorized official

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489363200000",
    "number": "1891231122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 WESTCHESTER AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551722",
            "telephone_number": "718-618-7692",
            "fax_number": "718-483-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 WESTCHESTER AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551722",
            "telephone_number": "917-570-5169",
            "fax_number": "718-483-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERDALE HEALTHY LIFE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-03-13",
        "status": "A",
        "authorized_official_last_name": "HADDAD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-570-5169"
    },
    "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": "034827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2167019",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-Road Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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 Mar 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.