1215387931 NPI number — SKS PHARMACY LLC

Table of content: (NPI 1215387931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215387931 NPI number — SKS PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKS PHARMACY LLC
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:
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:
1215387931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 LIVONIA AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11207-9524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-385-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 LIVONIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11207-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-385-6000
Provider Business Practice Location Address Fax Number:
718-385-6000
Provider Enumeration Date:
06/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RAHMAN
Authorized Official First Name:
SHAHARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
718-385-6000

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: 034594 , 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: 04586063 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2160598 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com