Provider Demographics
NPI:1679648257
Name:SYPRAM CORP
Entity Type:Organization
Organization Name:SYPRAM CORP
Other - Org Name:AKSHAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPVSY OF PHCY AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIVY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-220-2718
Mailing Address - Street 1:2200 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2029
Mailing Address - Country:US
Mailing Address - Phone:718-220-2748
Mailing Address - Fax:718-220-2749
Practice Address - Street 1:2200 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2029
Practice Address - Country:US
Practice Address - Phone:718-220-2748
Practice Address - Fax:718-220-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0267063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571259Medicaid
3338957OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02571259Medicaid