Provider Demographics
NPI:1588239552
Name:SUPER HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:SUPER HEALTH PHARMACY LLC
Other - Org Name:SUPER HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-967-4600
Mailing Address - Street 1:6390 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3155
Mailing Address - Country:US
Mailing Address - Phone:718-967-4600
Mailing Address - Fax:718-967-4601
Practice Address - Street 1:6390 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3155
Practice Address - Country:US
Practice Address - Phone:718-967-4600
Practice Address - Fax:718-967-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04714256Medicaid