Provider Demographics
NPI:1104846492
Name:CANALBERRY CORP.
Entity Type:Organization
Organization Name:CANALBERRY CORP.
Other - Org Name:CANALBERRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-619-6190
Mailing Address - Street 1:82 MULBERRY ST FRNT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4450
Mailing Address - Country:US
Mailing Address - Phone:212-619-6190
Mailing Address - Fax:212-619-6191
Practice Address - Street 1:82 MULBERRY ST FRNT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4450
Practice Address - Country:US
Practice Address - Phone:212-619-6190
Practice Address - Fax:212-619-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047089183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602537Medicaid
NY5305480001Medicare NSC