Provider Demographics
NPI:1578706586
Name:OPTIMA PHARMACY INC.
Entity Type:Organization
Organization Name:OPTIMA PHARMACY INC.
Other - Org Name:OPTIMA DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-424-9275
Mailing Address - Street 1:9101 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7919
Mailing Address - Country:US
Mailing Address - Phone:718-424-9275
Mailing Address - Fax:718-424-1289
Practice Address - Street 1:9101 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7919
Practice Address - Country:US
Practice Address - Phone:718-424-9275
Practice Address - Fax:718-424-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6371800001Medicare NSC