Provider Demographics
NPI:1245605443
Name:CEDRA HEALTHCARE LLC
Entity Type:Organization
Organization Name:CEDRA HEALTHCARE LLC
Other - Org Name:CEDRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-836-8886
Mailing Address - Street 1:724 ELTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1244
Mailing Address - Country:US
Mailing Address - Phone:917-368-8886
Mailing Address - Fax:844-666-2066
Practice Address - Street 1:724 ELTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1244
Practice Address - Country:US
Practice Address - Phone:917-473-6030
Practice Address - Fax:844-666-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X, 3336C0004X
NY0338873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156010OtherPK