Provider Demographics
NPI:1275648693
Name:PAKAM PHARMACY INC
Entity Type:Organization
Organization Name:PAKAM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMACIST
Authorized Official - Phone:718-486-5255
Mailing Address - Street 1:597 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6406
Mailing Address - Country:US
Mailing Address - Phone:718-486-5255
Mailing Address - Fax:718-486-7210
Practice Address - Street 1:597 MARCY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-6406
Practice Address - Country:US
Practice Address - Phone:718-486-5255
Practice Address - Fax:718-486-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0175793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00733459Medicaid
NY5427430001Medicare UPIN