Provider Demographics
NPI:1083797096
Name:BRIGHT LAND INC
Entity Type:Organization
Organization Name:BRIGHT LAND INC
Other - Org Name:CHRIS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT OF CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-545-6666
Mailing Address - Street 1:2535 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3607
Mailing Address - Country:US
Mailing Address - Phone:718-545-6666
Mailing Address - Fax:718-274-9825
Practice Address - Street 1:2535 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3607
Practice Address - Country:US
Practice Address - Phone:718-545-6666
Practice Address - Fax:718-274-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0251633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02530321Medicaid
NY02530321Medicaid