Provider Demographics
NPI:1558348565
Name:FRIENDLY PHARMACY INC
Entity Type:Organization
Organization Name:FRIENDLY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAQI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-742-0001
Mailing Address - Street 1:389 E 138TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3099
Mailing Address - Country:US
Mailing Address - Phone:718-742-0001
Mailing Address - Fax:718-742-0011
Practice Address - Street 1:389 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3099
Practice Address - Country:US
Practice Address - Phone:718-742-0001
Practice Address - Fax:718-742-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2010-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026305333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02499076Medicaid
NY3335521OtherNCPDP
NY02499076Medicaid