Provider Demographics
NPI:1033257498
Name:EAST 16TH STREET PHARMACY, INC
Entity Type:Organization
Organization Name:EAST 16TH STREET PHARMACY, INC
Other - Org Name:GREENFIELD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-282-7660
Mailing Address - Street 1:1526 CORTELYOU RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5608
Mailing Address - Country:US
Mailing Address - Phone:718-282-7660
Mailing Address - Fax:718-282-5152
Practice Address - Street 1:1526 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5608
Practice Address - Country:US
Practice Address - Phone:718-282-7660
Practice Address - Fax:718-282-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3325998OtherNCPDP
NY01018482Medicaid
NY01018482Medicaid