Provider Demographics
NPI:1689660029
Name:KOTIYARK INC
Entity Type:Organization
Organization Name:KOTIYARK INC
Other - Org Name:BAYSHORE HOMECARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-888-0303
Mailing Address - Street 1:733 N BEERS ST
Mailing Address - Street 2:STE L1
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1513
Mailing Address - Country:US
Mailing Address - Phone:732-888-0303
Mailing Address - Fax:732-888-9621
Practice Address - Street 1:733 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1513
Practice Address - Country:US
Practice Address - Phone:732-888-0303
Practice Address - Fax:732-888-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00624200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3127289OtherNCPDP NUMBER OR NABP NUMB
NJ0907014Medicaid
NJ0007374Medicaid