Provider Demographics
NPI:1225043847
Name:RISHI PHARMACY CORP
Entity Type:Organization
Organization Name:RISHI PHARMACY CORP
Other - Org Name:OZ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMMAKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-8892
Mailing Address - Street 1:322 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5613
Practice Address - Country:US
Practice Address - Phone:718-292-8892
Practice Address - Fax:718-292-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0251873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3354747OtherOTHER ID NUMBER
NY02165828Medicaid
5008590001Medicare NSC