Provider Demographics
NPI:1619958386
Name:SVRH PHARMACY INC
Entity Type:Organization
Organization Name:SVRH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SURYANARAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-596-1688
Mailing Address - Street 1:161 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6337
Mailing Address - Country:US
Mailing Address - Phone:718-596-1688
Mailing Address - Fax:718-237-6078
Practice Address - Street 1:161 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6337
Practice Address - Country:US
Practice Address - Phone:718-596-1688
Practice Address - Fax:718-237-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017700OtherPHARMACY
NY00755202Medicaid
NY017700OtherPHARMACY