1063775096 NPI number — ZAMZAM PHARMACY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063775096 NPI number — ZAMZAM PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZAMZAM PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ZAMZAM PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063775096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 MORRIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10451-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-401-6799
Provider Business Mailing Address Fax Number:
718-401-6794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 MORRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10451-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-401-6799
Provider Business Practice Location Address Fax Number:
718-401-6794
Provider Enumeration Date:
06/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SIDDIQUI
Authorized Official First Name:
TARIQ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PRESIDENT, AO
Authorized Official Telephone Number:
718-401-6799

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 031333 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03485678 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2135773 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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