Provider Demographics
NPI:1588679120
Name:NEW HYDE PARK PHARMACY INC
Entity Type:Organization
Organization Name:NEW HYDE PARK PHARMACY INC
Other - Org Name:LAKEVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARTHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-354-3545
Mailing Address - Street 1:749 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2515
Mailing Address - Country:US
Mailing Address - Phone:516-354-3545
Mailing Address - Fax:516-358-7096
Practice Address - Street 1:749 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2515
Practice Address - Country:US
Practice Address - Phone:516-354-3545
Practice Address - Fax:516-358-7096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01137306Medicaid
NY01137306Medicaid