Provider Demographics
NPI:1356682025
Name:1721 CARNEGIE HILL PHARMACY INC
Entity Type:Organization
Organization Name:1721 CARNEGIE HILL PHARMACY INC
Other - Org Name:CARNEGIE HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-246-0020
Mailing Address - Street 1:1721 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5214
Mailing Address - Country:US
Mailing Address - Phone:212-246-0020
Mailing Address - Fax:212-246-0025
Practice Address - Street 1:1721 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5214
Practice Address - Country:US
Practice Address - Phone:212-246-0020
Practice Address - Fax:212-246-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0316043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5806952OtherNCPDP PROVIDER IDENTIFICATION NUMBER