Provider Demographics
NPI:1073689469
Name:AWADCARE PHARMACY INC
Entity Type:Organization
Organization Name:AWADCARE PHARMACY INC
Other - Org Name:CENTRAL VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-928-1117
Mailing Address - Street 1:228 ROUTE 32
Mailing Address - Street 2:OAK CLOVE MALL
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3649
Mailing Address - Country:US
Mailing Address - Phone:845-928-1117
Mailing Address - Fax:845-928-1120
Practice Address - Street 1:228 ROUTE 32
Practice Address - Street 2:OAK CLOVE MALL
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3649
Practice Address - Country:US
Practice Address - Phone:845-928-1117
Practice Address - Fax:845-928-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591028Medicaid
NY5264800001Medicare NSC