Provider Demographics
NPI:1235264052
Name:CRICOR HOLDINGS, INC.
Entity Type:Organization
Organization Name:CRICOR HOLDINGS, INC.
Other - Org Name:SUNNY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:CRICOR
Authorized Official - Last Name:DOLMAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-433-3091
Mailing Address - Street 1:4202 GREENPOINT AVE
Mailing Address - Street 2:B
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3004
Mailing Address - Country:US
Mailing Address - Phone:718-433-3091
Mailing Address - Fax:718-433-1657
Practice Address - Street 1:4202 GREENPOINT AVE
Practice Address - Street 2:B
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3004
Practice Address - Country:US
Practice Address - Phone:718-433-3091
Practice Address - Fax:718-433-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134114Medicaid
NY3321145OtherNCPDP
NY3321145OtherNCPDP