Provider Demographics
NPI:1093273500
Name:PLEASANT VALLEY CHEMISTS INC
Entity Type:Organization
Organization Name:PLEASANT VALLEY CHEMISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-635-2222
Mailing Address - Street 1:13 NORTH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7943
Mailing Address - Country:US
Mailing Address - Phone:845-635-2222
Mailing Address - Fax:
Practice Address - Street 1:13 NORTH AVE STE 1
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7943
Practice Address - Country:US
Practice Address - Phone:845-635-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03739324Medicaid