Provider Demographics
NPI:1235248865
Name:DIN PHARMACY CORP
Entity Type:Organization
Organization Name:DIN PHARMACY CORP
Other - Org Name:DIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VASAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKILAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-4528
Mailing Address - Street 1:18 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5030
Mailing Address - Country:US
Mailing Address - Phone:212-928-4528
Mailing Address - Fax:212-568-8699
Practice Address - Street 1:18 MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5030
Practice Address - Country:US
Practice Address - Phone:212-928-4528
Practice Address - Fax:212-568-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00886062Medicaid
0842040001Medicare NSC