Provider Demographics
NPI:1467461996
Name:ELMHURST PHARMACY, INC.
Entity Type:Organization
Organization Name:ELMHURST PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST R.PH
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS RPH
Authorized Official - Phone:718-565-8667
Mailing Address - Street 1:7523 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5612
Mailing Address - Country:US
Mailing Address - Phone:718-565-8667
Mailing Address - Fax:
Practice Address - Street 1:7523 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5612
Practice Address - Country:US
Practice Address - Phone:718-565-8667
Practice Address - Fax:718-565-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0208583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01612037Medicaid
NY01612037Medicaid