Provider Demographics
NPI:1124032545
Name:GAYATRI PHARMACY INC
Entity Type:Organization
Organization Name:GAYATRI PHARMACY INC
Other - Org Name:UNIVERSITY AVENUE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DHANESH
Authorized Official - Middle Name:BHOGILAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:SUPERVISING-RPH
Authorized Official - Phone:718-220-4253
Mailing Address - Street 1:2465 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5602
Mailing Address - Country:US
Mailing Address - Phone:718-220-4253
Mailing Address - Fax:718-584-6824
Practice Address - Street 1:2465 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5602
Practice Address - Country:US
Practice Address - Phone:718-220-4253
Practice Address - Fax:718-584-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0234543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01764901Medicaid
NY5911290001Medicare NSC