Provider Demographics
NPI:1508842931
Name:SHANTI PHARMACY CORP
Entity Type:Organization
Organization Name:SHANTI PHARMACY CORP
Other - Org Name:SILVER ROD DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MILIND
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUVARNAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-922-3400
Mailing Address - Street 1:5105 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3511
Mailing Address - Country:US
Mailing Address - Phone:718-922-3400
Mailing Address - Fax:718-922-0348
Practice Address - Street 1:5105 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3511
Practice Address - Country:US
Practice Address - Phone:718-922-3400
Practice Address - Fax:718-922-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020652333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199600Medicaid
NY5111390001Medicare NSC