Provider Demographics
NPI:1508940636
Name:ABRIN PHARMACY
Entity Type:Organization
Organization Name:ABRIN PHARMACY
Other - Org Name:R AND C PHARM CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPRV PHARM
Authorized Official - Prefix:
Authorized Official - First Name:RATHINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-529-1130
Mailing Address - Street 1:13113 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:S OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2931
Mailing Address - Country:US
Mailing Address - Phone:718-529-1130
Mailing Address - Fax:718-659-8833
Practice Address - Street 1:13113 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:S OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2931
Practice Address - Country:US
Practice Address - Phone:718-529-1130
Practice Address - Fax:718-659-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0217033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01417514Medicaid
3337234OtherNCPDP PROVIDER IDENTIFICATION NUMBER