Provider Demographics
NPI:1346339447
Name:ESJAY PHARMACY CORP
Entity Type:Organization
Organization Name:ESJAY PHARMACY CORP
Other - Org Name:UNITED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-384-7901
Mailing Address - Street 1:556 GRAND ST
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4386
Mailing Address - Country:US
Mailing Address - Phone:718-384-7901
Mailing Address - Fax:718-218-8591
Practice Address - Street 1:556 GRAND ST
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4386
Practice Address - Country:US
Practice Address - Phone:718-384-7901
Practice Address - Fax:718-218-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01588889Medicaid
NY1124580001Medicare ID - Type UnspecifiedPHARMACY PROVIDER