Provider Demographics
NPI:1477882538
Name:CIRCLE PHARMACY CORP
Entity Type:Organization
Organization Name:CIRCLE PHARMACY CORP
Other - Org Name:CIRCLE PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOOFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-823-6666
Mailing Address - Street 1:116 HUGH J GRANT CIR
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5065
Mailing Address - Country:US
Mailing Address - Phone:718-823-6666
Mailing Address - Fax:718-823-6661
Practice Address - Street 1:116 HUGH J GRANT CIR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5065
Practice Address - Country:US
Practice Address - Phone:718-823-6666
Practice Address - Fax:718-823-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0298823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3186514Medicaid
2123334OtherPK