Provider Demographics
NPI:1164861837
Name:HANCOCK PHARMACY INC
Entity Type:Organization
Organization Name:HANCOCK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-497-7000
Mailing Address - Street 1:715 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-5337
Mailing Address - Country:US
Mailing Address - Phone:718-497-7000
Mailing Address - Fax:718-497-8000
Practice Address - Street 1:715 KNICKERBOCKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5337
Practice Address - Country:US
Practice Address - Phone:718-497-7000
Practice Address - Fax:718-497-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031928OtherNEW YORK STATE BOARD OF PHARMACY
NY03868100Medicaid
NY7078950001Medicare NSC