Provider Demographics
NPI:1437394822
Name:RIDGEWOOD CITY PHARMACY INC.
Entity Type:Organization
Organization Name:RIDGEWOOD CITY PHARMACY INC.
Other - Org Name:RIDGEWOOD CITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAPOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-381-7766
Mailing Address - Street 1:775 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4127
Mailing Address - Country:US
Mailing Address - Phone:718-381-7766
Mailing Address - Fax:718-381-7765
Practice Address - Street 1:775 SENECA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4127
Practice Address - Country:US
Practice Address - Phone:718-381-7766
Practice Address - Fax:718-381-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029140333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118467OtherPK
NY3074480Medicaid
2118467OtherPK