Provider Demographics
NPI:1790073906
Name:PRIME HEALTH INC
Entity Type:Organization
Organization Name:PRIME HEALTH INC
Other - Org Name:THE CHEMIST SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SUPERVISING PHARMACI
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-472-0900
Mailing Address - Street 1:3015 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-2609
Mailing Address - Country:US
Mailing Address - Phone:718-472-0900
Mailing Address - Fax:718-472-0909
Practice Address - Street 1:3015 38TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2609
Practice Address - Country:US
Practice Address - Phone:718-472-0900
Practice Address - Fax:718-472-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0307543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131265OtherPK
NY03368467Medicaid
2131265OtherPK