Provider Demographics
NPI:1326705781
Name:ONE FAMILY PHARMACY INC.
Entity Type:Organization
Organization Name:ONE FAMILY PHARMACY INC.
Other - Org Name:PRIME CARE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-255-1813
Mailing Address - Street 1:9608 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1046
Mailing Address - Country:US
Mailing Address - Phone:718-255-1813
Mailing Address - Fax:718-255-1873
Practice Address - Street 1:9608 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1046
Practice Address - Country:US
Practice Address - Phone:718-255-1813
Practice Address - Fax:718-255-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039213OtherPHARMACY REGISTRATION