Provider Demographics
NPI:1285679480
Name:PALACE PHARMACY INC
Entity Type:Organization
Organization Name:PALACE PHARMACY INC
Other - Org Name:PALACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND SUPV PHCIST
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMDOUG SABRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-459-2518
Mailing Address - Street 1:543 MALCOLM X BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:543 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1806
Practice Address - Country:US
Practice Address - Phone:212-283-2136
Practice Address - Fax:212-283-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027539333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3350814OtherOTHER ID NUMBER-COMMERCIAL NUMBER