Provider Demographics
NPI:1225311020
Name:HYATT PHARMACY INC
Entity Type:Organization
Organization Name:HYATT PHARMACY INC
Other - Org Name:HYATT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-808-7726
Mailing Address - Street 1:2321 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4183
Mailing Address - Country:US
Mailing Address - Phone:347-808-7726
Mailing Address - Fax:347-808-7728
Practice Address - Street 1:2321 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4183
Practice Address - Country:US
Practice Address - Phone:347-808-7726
Practice Address - Fax:347-808-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0309103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03455438Medicaid
2131986OtherPK