Provider Demographics
NPI:1568556769
Name:AMI PHARMACY INC.
Entity Type:Organization
Organization Name:AMI PHARMACY INC.
Other - Org Name:ST JESUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RASIK
Authorized Official - Middle Name:
Authorized Official - Last Name:VIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-923-5733
Mailing Address - Street 1:4180 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3736
Mailing Address - Country:US
Mailing Address - Phone:212-923-5733
Mailing Address - Fax:212-923-5748
Practice Address - Street 1:4180 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3736
Practice Address - Country:US
Practice Address - Phone:212-923-5733
Practice Address - Fax:212-923-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0228473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016412Medicaid
3385247OtherNCPDP
NY016412Medicaid