Provider Demographics
NPI:1205178951
Name:ALLEN STREET PHARMACY INC
Entity Type:Organization
Organization Name:ALLEN STREET PHARMACY INC
Other - Org Name:ALLEN STREET PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIN ZHUI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-966-8287
Mailing Address - Street 1:2 ALLEN ST
Mailing Address - Street 2:1C/1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5302
Mailing Address - Country:US
Mailing Address - Phone:212-966-8287
Mailing Address - Fax:212-966-8289
Practice Address - Street 1:2 ALLEN ST
Practice Address - Street 2:1A/1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-5302
Practice Address - Country:US
Practice Address - Phone:212-966-8287
Practice Address - Fax:212-966-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0318003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03581335Medicaid
2139688OtherPK
NY6758960001Medicare NSC