Provider Demographics
NPI:1609324086
Name:PRAMUKH PHARMACY LLC
Entity Type:Organization
Organization Name:PRAMUKH PHARMACY LLC
Other - Org Name:PAGODA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-673-0588
Mailing Address - Street 1:1220 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1458
Mailing Address - Country:US
Mailing Address - Phone:610-236-0911
Mailing Address - Fax:610-236-0993
Practice Address - Street 1:810 OLEY ST STE G2
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-2546
Practice Address - Country:US
Practice Address - Phone:484-577-4408
Practice Address - Fax:484-509-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164159OtherPK