Provider Demographics
NPI:1467482489
Name:PARUL PHARMACY INC
Entity Type:Organization
Organization Name:PARUL PHARMACY INC
Other - Org Name:RAAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-581-4285
Mailing Address - Street 1:48 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1415
Mailing Address - Country:US
Mailing Address - Phone:631-581-4285
Mailing Address - Fax:631-581-4313
Practice Address - Street 1:48 LOWELL AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1415
Practice Address - Country:US
Practice Address - Phone:631-581-4285
Practice Address - Fax:631-581-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0192723336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01000788Medicaid
NY01000788Medicaid