Provider Demographics
NPI:1114090370
Name:BALAJI TARGEE PHARMACY INC
Entity Type:Organization
Organization Name:BALAJI TARGEE PHARMACY INC
Other - Org Name:BALAJI TARGEE PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:IRSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-720-7205
Mailing Address - Street 1:519 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3501
Mailing Address - Country:US
Mailing Address - Phone:718-720-7205
Mailing Address - Fax:718-981-1512
Practice Address - Street 1:519 TARGEE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3501
Practice Address - Country:US
Practice Address - Phone:718-720-7205
Practice Address - Fax:718-981-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0184783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2062350OtherPK
NY00875672Medicaid
3382796OtherNCPDP PROVIDER IDENTIFICATION NUMBER