Provider Demographics
NPI:1750667598
Name:ARDENT PHARMACY INC
Entity Type:Organization
Organization Name:ARDENT PHARMACY INC
Other - Org Name:BENJAMIN'S PHARMACY AND SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENIAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:516-398-8183
Mailing Address - Street 1:987-989 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4336
Mailing Address - Country:US
Mailing Address - Phone:718-405-9111
Mailing Address - Fax:718-405-9112
Practice Address - Street 1:987-989 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4336
Practice Address - Country:US
Practice Address - Phone:718-405-9111
Practice Address - Fax:718-405-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050685332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03418224Medicaid
NY03418224Medicaid