Provider Demographics
NPI:1154627834
Name:UNITED PHARM USA, INC
Entity Type:Organization
Organization Name:UNITED PHARM USA, INC
Other - Org Name:GSTPHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-613-0884
Mailing Address - Street 1:15218 UNION TPKE APT 3B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3952
Mailing Address - Country:US
Mailing Address - Phone:917-613-9884
Mailing Address - Fax:718-591-4495
Practice Address - Street 1:669 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4803
Practice Address - Country:US
Practice Address - Phone:718-963-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336314012OtherNPI
6550280001Medicare NSC