Provider Demographics
NPI:1639247877
Name:Y AND Z PHARMACY INC
Entity Type:Organization
Organization Name:Y AND Z PHARMACY INC
Other - Org Name:M AND M PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN PHAR
Authorized Official - Phone:718-337-1680
Mailing Address - Street 1:1901 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6201
Mailing Address - Country:US
Mailing Address - Phone:718-377-1680
Mailing Address - Fax:718-951-7520
Practice Address - Street 1:1901 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6201
Practice Address - Country:US
Practice Address - Phone:718-377-1680
Practice Address - Fax:718-951-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0229553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01650320Medicaid
2060926OtherPK
NY01650320Medicaid