Provider Demographics
NPI:1740387687
Name:AREESHA PHARMACY INC
Entity Type:Organization
Organization Name:AREESHA PHARMACY INC
Other - Org Name:OCEANSIDE PHARMACY AND SUPER MARKET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANG
Authorized Official - Prefix:
Authorized Official - First Name:FAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:L
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-996-4949
Mailing Address - Street 1:3206 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1810
Mailing Address - Country:US
Mailing Address - Phone:718-996-4949
Mailing Address - Fax:718-996-3676
Practice Address - Street 1:3206 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1810
Practice Address - Country:US
Practice Address - Phone:718-996-4949
Practice Address - Fax:718-996-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0284463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059878OtherPK
NY2867650Medicaid
NY02867650Medicaid