Provider Demographics
NPI:1053495184
Name:SLV PHARMACY INC
Entity Type:Organization
Organization Name:SLV PHARMACY INC
Other - Org Name:FROST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-457-3192
Mailing Address - Street 1:86 52 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-457-3192
Mailing Address - Fax:718-397-0791
Practice Address - Street 1:86 52 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4486
Practice Address - Country:US
Practice Address - Phone:718-457-3192
Practice Address - Fax:718-397-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0225773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064515OtherPK
NY01560383Medicaid
2064515OtherPK