1114283512 NPI number — DHAKA PHARMACY INC

Table of content: (NPI 1114283512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114283512 NPI number — DHAKA PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHAKA 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:
BROADWAY CORNER
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:
1114283512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4026 75TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-426-4727
Provider Business Mailing Address Fax Number:
718-426-4729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4026 75TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-426-4727
Provider Business Practice Location Address Fax Number:
718-426-4729
Provider Enumeration Date:
04/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOSSAIN
Authorized Official First Name:
MAHMUD
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISING PHARMACIST
Authorized Official Telephone Number:
718-426-4727

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: 031253 , 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: 5804972 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com