Provider Demographics
NPI:1790820512
Name:SAS PHARMACY INC
Entity Type:Organization
Organization Name:SAS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:DIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-823-5330
Mailing Address - Street 1:1481 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-3901
Mailing Address - Country:US
Mailing Address - Phone:718-823-5330
Mailing Address - Fax:718-823-5348
Practice Address - Street 1:1481 LELAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-3901
Practice Address - Country:US
Practice Address - Phone:718-823-5330
Practice Address - Fax:718-823-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016900333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02083585Medicaid
NY3370549Medicare UPIN
NY02083585Medicaid