Provider Demographics
NPI:1417180464
Name:APEX PHARMACY, INC.
Entity Type:Organization
Organization Name:APEX PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRANAV
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-848-4900
Mailing Address - Street 1:11449 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-1022
Mailing Address - Country:US
Mailing Address - Phone:718-848-4900
Mailing Address - Fax:718-848-4903
Practice Address - Street 1:11449 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1022
Practice Address - Country:US
Practice Address - Phone:718-848-4900
Practice Address - Fax:718-848-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029644333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161828Medicaid
NY03161828Medicaid