Provider Demographics
NPI:1467517623
Name:ANISH PHARMACY
Entity Type:Organization
Organization Name:ANISH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-777-1100
Mailing Address - Street 1:2650 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4126
Mailing Address - Country:US
Mailing Address - Phone:718-777-1100
Mailing Address - Fax:
Practice Address - Street 1:2650 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11102-4126
Practice Address - Country:US
Practice Address - Phone:718-777-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027110332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy