Provider Demographics
NPI:1447576368
Name:ELMONT PHARMACY INC
Entity Type:Organization
Organization Name:ELMONT PHARMACY INC
Other - Org Name:CARE MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-869-9559
Mailing Address - Street 1:13046 LAURELTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1219
Mailing Address - Country:US
Mailing Address - Phone:718-869-9559
Mailing Address - Fax:718-467-7002
Practice Address - Street 1:1604 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1124
Practice Address - Country:US
Practice Address - Phone:718-467-7000
Practice Address - Fax:718-467-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0301573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126430OtherPK
NY3274215Medicaid
NY3274215Medicaid