Provider Demographics
NPI:1407308620
Name:MOIN & SIRAJ GROUP PHARMACY INC
Entity Type:Organization
Organization Name:MOIN & SIRAJ GROUP PHARMACY INC
Other - Org Name:QRX3 PHARMACY & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-809-2396
Mailing Address - Street 1:962 E TIOGA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1307
Mailing Address - Country:US
Mailing Address - Phone:267-606-6363
Mailing Address - Fax:267-606-6569
Practice Address - Street 1:962 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1307
Practice Address - Country:US
Practice Address - Phone:267-606-6363
Practice Address - Fax:267-606-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166354OtherPK