Provider Demographics
NPI:1679630412
Name:GSSV PHARMACY INC.
Entity Type:Organization
Organization Name:GSSV PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SUBBARAO
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:SANNIDHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-361-2084
Mailing Address - Street 1:4002 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3302
Mailing Address - Country:US
Mailing Address - Phone:718-361-2084
Mailing Address - Fax:718-729-3211
Practice Address - Street 1:4002 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3302
Practice Address - Country:US
Practice Address - Phone:718-361-2084
Practice Address - Fax:718-729-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801105Medicaid