Provider Demographics
NPI:1598044216
Name:VAISHNAVI PHARMACY INC
Entity Type:Organization
Organization Name:VAISHNAVI PHARMACY INC
Other - Org Name:GOOD HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BALAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDDUKURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-618-7425
Mailing Address - Street 1:1379 NOSTRAND AVE # 83
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2596
Mailing Address - Country:US
Mailing Address - Phone:718-618-7425
Mailing Address - Fax:718-618-7428
Practice Address - Street 1:1379 NOSTRAND AVE # 83
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2596
Practice Address - Country:US
Practice Address - Phone:718-618-7425
Practice Address - Fax:718-618-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5803069OtherNCPDP
NY030788OtherBOARD OF PHARMACY REGISTRATION
NY03394772Medicaid
6679850001Medicare NSC