Provider Demographics
NPI:1659317030
Name:MELBRAN DRUGS INC
Entity Type:Organization
Organization Name:MELBRAN DRUGS INC
Other - Org Name:MELBRAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SURANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-568-1300
Mailing Address - Street 1:605 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3705
Mailing Address - Country:US
Mailing Address - Phone:212-568-1300
Mailing Address - Fax:212-927-3960
Practice Address - Street 1:605 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3705
Practice Address - Country:US
Practice Address - Phone:212-568-1300
Practice Address - Fax:212-927-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0276133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673210Medicaid
2061094OtherPK
2061094OtherPK