Provider Demographics
NPI:1578606430
Name:MT.VERNON PRESCRIPTION INC.
Entity Type:Organization
Organization Name:MT.VERNON PRESCRIPTION INC.
Other - Org Name:VERNON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GIRISH
Authorized Official - Middle Name:RASIKLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:REGPHARMACIST
Authorized Official - Phone:914-664-0300
Mailing Address - Street 1:105 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2686
Mailing Address - Country:US
Mailing Address - Phone:914-664-0300
Mailing Address - Fax:914-664-0857
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-664-0300
Practice Address - Fax:914-664-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020574333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3396327OtherNABP NUMBER
NY01177802Medicaid
NY5235630001Medicare NSC