Provider Demographics
NPI:1093856866
Name:PARK HEALTH PHARMACY INC
Entity Type:Organization
Organization Name:PARK HEALTH PHARMACY INC
Other - Org Name:PARKHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:718-322-3261
Mailing Address - Street 1:13124 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2932
Mailing Address - Country:US
Mailing Address - Phone:718-322-3261
Mailing Address - Fax:718-322-3261
Practice Address - Street 1:13124 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2932
Practice Address - Country:US
Practice Address - Phone:718-322-3261
Practice Address - Fax:718-322-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01813345Medicaid