Provider Demographics
NPI:1346593779
Name:HOSP PHARMA LLC
Entity Type:Organization
Organization Name:HOSP PHARMA LLC
Other - Org Name:THRIFTCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-638-3800
Mailing Address - Street 1:759 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4504
Mailing Address - Country:US
Mailing Address - Phone:718-638-3800
Mailing Address - Fax:718-638-0239
Practice Address - Street 1:759 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4504
Practice Address - Country:US
Practice Address - Phone:718-638-3800
Practice Address - Fax:718-638-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0317703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139499OtherPK
NY03510556Medicaid
6740720001Medicare NSC