Provider Demographics
NPI:1396361259
Name:BANANI ROAD 11 LLC
Entity Type:Organization
Organization Name:BANANI ROAD 11 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-531-8436
Mailing Address - Street 1:181-04 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-480-8700
Mailing Address - Fax:718-480-1888
Practice Address - Street 1:181-04 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-480-8700
Practice Address - Fax:718-480-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy