Provider Demographics
NPI:1093812935
Name:NEWBURGH PHARMACY INC
Entity Type:Organization
Organization Name:NEWBURGH PHARMACY INC
Other - Org Name:NEWBURGH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUHAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRPH
Authorized Official - Phone:845-561-1771
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5157
Mailing Address - Country:US
Mailing Address - Phone:845-561-1771
Mailing Address - Fax:845-561-2442
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5157
Practice Address - Country:US
Practice Address - Phone:845-561-1771
Practice Address - Fax:845-561-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0279923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02784765Medicaid
2068341OtherPK
2068341OtherPK