Provider Demographics
NPI:1255494324
Name:SHREE YASH CORP
Entity Type:Organization
Organization Name:SHREE YASH CORP
Other - Org Name:PALISADE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-222-9399
Mailing Address - Street 1:338 PALISADE AVE
Mailing Address - Street 2:PALISADE DRUGS
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1719
Mailing Address - Country:US
Mailing Address - Phone:201-222-9399
Mailing Address - Fax:201-222-0255
Practice Address - Street 1:338 PALISADE AVE
Practice Address - Street 2:PALISADE DRUGS
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1753
Practice Address - Country:US
Practice Address - Phone:201-222-9399
Practice Address - Fax:201-222-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00648700332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072117Medicaid
NJ0072117Medicaid