Provider Demographics
NPI:1437184991
Name:ATLURI PHARMACY INC.
Entity Type:Organization
Organization Name:ATLURI PHARMACY INC.
Other - Org Name:LACONIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:V
Authorized Official - Last Name:ATLURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-798-6262
Mailing Address - Street 1:3977 LACONIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4916
Mailing Address - Country:US
Mailing Address - Phone:718-798-6262
Mailing Address - Fax:
Practice Address - Street 1:3977 LACONIA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4916
Practice Address - Country:US
Practice Address - Phone:718-798-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0230183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01660186Medicaid
NY4880800001Medicare NSC