Provider Demographics
NPI:1407949183
Name:PARK IRMAT DRUG CORP
Entity Type:Organization
Organization Name:PARK IRMAT DRUG CORP
Other - Org Name:IRMAT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANAKIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AJJARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-888-1001
Mailing Address - Street 1:2 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5675
Mailing Address - Country:US
Mailing Address - Phone:212-685-0500
Mailing Address - Fax:212-532-6596
Practice Address - Street 1:2 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5675
Practice Address - Country:US
Practice Address - Phone:212-685-0500
Practice Address - Fax:212-532-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336M0002X
NY0216453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059949OtherPK
NY01463809Medicaid
1291460001Medicare NSC