Provider Demographics
NPI:1053449249
Name:MNK PHARMACY INC
Entity Type:Organization
Organization Name:MNK PHARMACY INC
Other - Org Name:CHATEAU DRUG & HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUBASHKY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-877-6390
Mailing Address - Street 1:181 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-877-6390
Mailing Address - Fax:212-877-6706
Practice Address - Street 1:181 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-877-6390
Practice Address - Fax:212-877-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01285258Medicaid