Provider Demographics
NPI:1023197530
Name:AAUSADH INC
Entity Type:Organization
Organization Name:AAUSADH INC
Other - Org Name:AAUSADH PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PUNITA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-972-2780
Mailing Address - Street 1:4615 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1254
Mailing Address - Country:US
Mailing Address - Phone:718-972-2780
Mailing Address - Fax:718-435-8081
Practice Address - Street 1:4615 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1254
Practice Address - Country:US
Practice Address - Phone:718-972-2780
Practice Address - Fax:718-435-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01539000Medicaid
NY01539000Medicaid