Provider Demographics
NPI:1225109416
Name:MORAMI PHARMACY, INC
Entity Type:Organization
Organization Name:MORAMI PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YU
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-886-9100
Mailing Address - Street 1:4030 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4934
Mailing Address - Country:US
Mailing Address - Phone:718-886-9100
Mailing Address - Fax:718-886-5775
Practice Address - Street 1:4030 MURRAY ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4934
Practice Address - Country:US
Practice Address - Phone:718-886-9100
Practice Address - Fax:718-886-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023314OtherSTATE LICENSE
NY01753300Medicaid
NY4808310001Medicare ID - Type Unspecified