Provider Demographics
NPI:1235576851
Name:NISHKAM
Entity Type:Organization
Organization Name:NISHKAM
Other - Org Name:ST PAUL'S NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-293-8810
Mailing Address - Street 1:3750A 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2102
Mailing Address - Country:US
Mailing Address - Phone:718-293-8810
Mailing Address - Fax:718-293-8789
Practice Address - Street 1:3750A 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2102
Practice Address - Country:US
Practice Address - Phone:718-293-8810
Practice Address - Fax:718-293-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0320793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03662402Medicaid
2142035OtherPK
NY03662402Medicaid