Provider Demographics
NPI:1275275885
Name:MODERN PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:MODERN PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAGATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-258-1753
Mailing Address - Street 1:9502 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1638
Mailing Address - Country:US
Mailing Address - Phone:888-585-6874
Mailing Address - Fax:917-764-8038
Practice Address - Street 1:9502 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1638
Practice Address - Country:US
Practice Address - Phone:888-585-6874
Practice Address - Fax:917-764-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039465OtherNEW YORK STATE EDUCATION DEPARTMENT BOARD OFFICE FOR PHARMACY & MIDWIFERY