Provider Demographics
NPI:1730297458
Name:S R AHMAD, INC.
Entity Type:Organization
Organization Name:S R AHMAD, INC.
Other - Org Name:VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SARDAR
Authorized Official - Middle Name:RAFIQ
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-539-9323
Mailing Address - Street 1:12 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165
Mailing Address - Country:US
Mailing Address - Phone:315-539-9323
Mailing Address - Fax:315-539-4146
Practice Address - Street 1:12 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1329
Practice Address - Country:US
Practice Address - Phone:315-539-9323
Practice Address - Fax:315-539-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020371332B00000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01153626Medicaid
NYA0801040Medicare ID - Type UnspecifiedSUBMITTER NUMBER
NYZA17096BMedicare ID - Type UnspecifiedMEDICARE BILLING
NY0767770001Medicare NSC