Provider Demographics
NPI:1396820593
Name:NEW PELHAM PARKWAY PHARMACY INC.
Entity Type:Organization
Organization Name:NEW PELHAM PARKWAY PHARMACY INC.
Other - Org Name:PELHAM PARKWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:QADEER
Authorized Official - Last Name:CHOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-409-0908
Mailing Address - Street 1:1469 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-3630
Mailing Address - Country:US
Mailing Address - Phone:718-409-0908
Mailing Address - Fax:718-822-3127
Practice Address - Street 1:1469 BEACH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-3630
Practice Address - Country:US
Practice Address - Phone:718-409-0908
Practice Address - Fax:718-822-3127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022512333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01568941Medicaid
5118620001Medicare ID - Type Unspecified
NY01568941Medicaid