Provider Demographics
NPI:1043871775
Name:SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-602-0499
Mailing Address - Street 1:819 S SALINA ST STE B
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3527
Mailing Address - Country:US
Mailing Address - Phone:315-515-5839
Mailing Address - Fax:315-295-2750
Practice Address - Street 1:819 S SALINA ST STE B
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3527
Practice Address - Country:US
Practice Address - Phone:315-515-5839
Practice Address - Fax:315-295-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy