Provider Demographics
NPI:1639287485
Name:OHM DRUG CORP
Entity Type:Organization
Organization Name:OHM DRUG CORP
Other - Org Name:QUEENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARMILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHHUGANI
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARMACY
Authorized Official - Phone:718-459-2400
Mailing Address - Street 1:97-30 64 ROAD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2233
Mailing Address - Country:US
Mailing Address - Phone:718-459-2400
Mailing Address - Fax:718-459-4011
Practice Address - Street 1:97-30 64 ROAD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2233
Practice Address - Country:US
Practice Address - Phone:718-459-2400
Practice Address - Fax:718-459-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744512Medicaid
NY02744512Medicaid