1942283882 NPI number — SHREE NATH PHARMACY CORP

Table of content: (NPI 1942283882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942283882 NPI number — SHREE NATH PHARMACY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHREE NATH PHARMACY CORP
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:
Provider Other Organization Name Type Code:
6
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:
1942283882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1576 ST NICHOLAS AVE
Provider Second Line Business Mailing Address:
SHREE NATH PHARMACY CORP
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-795-1795
Provider Business Mailing Address Fax Number:
212-740-7868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1576 ST NICHOLAS AVE
Provider Second Line Business Practice Location Address:
SHREE NATH PHARMACY CORP
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-795-1795
Provider Business Practice Location Address Fax Number:
212-740-7868
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
HASMUKH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHARMACIST, PRESIDENT
Authorized Official Telephone Number:
212-795-1795

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01602446 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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