Provider Demographics
NPI:1477806164
Name:PLEASANT VALLEY CHEMISTS INC
Entity Type:Organization
Organization Name:PLEASANT VALLEY CHEMISTS INC
Other - Org Name:NEIGHBORX PHARMACY AT PLEASANT VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-635-2222
Mailing Address - Street 1:13 NORTH AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7943
Mailing Address - Country:US
Mailing Address - Phone:845-635-2222
Mailing Address - Fax:845-635-9222
Practice Address - Street 1:13 NORTH AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7943
Practice Address - Country:US
Practice Address - Phone:845-635-2222
Practice Address - Fax:845-635-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0317303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137495OtherPK
NY03739324Medicaid