Provider Demographics
NPI:1114942968
Name:ASTORIA PHARMACY INC
Entity Type:Organization
Organization Name:ASTORIA PHARMACY INC
Other - Org Name:HILLSIDE ASTORIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:
Authorized Official - First Name:SHAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-278-3772
Mailing Address - Street 1:14805 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3330
Mailing Address - Country:US
Mailing Address - Phone:718-278-3772
Mailing Address - Fax:718-278-2716
Practice Address - Street 1:14805 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3330
Practice Address - Country:US
Practice Address - Phone:718-278-3772
Practice Address - Fax:718-278-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0214563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01404200Medicaid
NY0773450001Medicare NSC