Provider Demographics
NPI:1275569451
Name:UNITED PHARMACY LLC
Entity Type:Organization
Organization Name:UNITED PHARMACY LLC
Other - Org Name:UNITED PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-884-2500
Mailing Address - Street 1:5539 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5217
Mailing Address - Country:US
Mailing Address - Phone:718-884-2500
Mailing Address - Fax:718-884-7500
Practice Address - Street 1:5539 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5217
Practice Address - Country:US
Practice Address - Phone:718-884-2500
Practice Address - Fax:718-884-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0264343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2061592OtherPK
NY02513019Medicaid
5044610001Medicare NSC