Provider Demographics
NPI:1023022944
Name:ASHBURTONAVEPHARMACY
Entity Type:Organization
Organization Name:ASHBURTONAVEPHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRANATHREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-963-4525
Mailing Address - Street 1:180 ASHBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3201
Mailing Address - Country:US
Mailing Address - Phone:914-963-4525
Mailing Address - Fax:914-963-4611
Practice Address - Street 1:180 ASHBURTON AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3201
Practice Address - Country:US
Practice Address - Phone:914-963-4525
Practice Address - Fax:914-963-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5769720001OtherDMEPOS SUPPLIER
NY027703Medicaid