Provider Demographics
NPI:1174510192
Name:SRI PHARMACY, INC
Entity Type:Organization
Organization Name:SRI PHARMACY, INC
Other - Org Name:JUNCTION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSSOUF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-421-3600
Mailing Address - Street 1:2109 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3001
Mailing Address - Country:US
Mailing Address - Phone:718-421-3600
Mailing Address - Fax:718-434-4341
Practice Address - Street 1:2109 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3001
Practice Address - Country:US
Practice Address - Phone:718-421-3600
Practice Address - Fax:718-434-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027440333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664602Medicaid
NY5498050001Medicare NSC