Provider Demographics
NPI:1407880479
Name:PANCARE PHARMACY INC
Entity Type:Organization
Organization Name:PANCARE PHARMACY INC
Other - Org Name:PANCARE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-240-2312
Mailing Address - Street 1:22 BOWERY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5102
Mailing Address - Country:US
Mailing Address - Phone:212-240-2312
Mailing Address - Fax:212-240-2308
Practice Address - Street 1:22 BOWERY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5102
Practice Address - Country:US
Practice Address - Phone:212-240-2312
Practice Address - Fax:212-240-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0261653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2060250OtherPK
NY02423229Medicaid
NY02423229Medicaid