Provider Demographics
NPI:1376502187
Name:2000 NINOS PHARMACY,INC
Entity Type:Organization
Organization Name:2000 NINOS PHARMACY,INC
Other - Org Name:2000 NINOS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANICKARAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-491-2910
Mailing Address - Street 1:3663 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-2449
Mailing Address - Country:US
Mailing Address - Phone:212-491-2910
Mailing Address - Fax:
Practice Address - Street 1:601 W 150TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2449
Practice Address - Country:US
Practice Address - Phone:212-491-2910
Practice Address - Fax:212-491-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0228803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01633036Medicaid
3313789OtherOTHER ID NUMBER
NY01633036Medicaid