Provider Demographics
NPI:1811208465
Name:AL-SHIFA PHARMACY INC
Entity Type:Organization
Organization Name:AL-SHIFA PHARMACY INC
Other - Org Name:VISTA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-417-9031
Mailing Address - Street 1:236 BUSHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2711
Mailing Address - Country:US
Mailing Address - Phone:718-417-9031
Mailing Address - Fax:718-417-5416
Practice Address - Street 1:236 BUSHWICK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2711
Practice Address - Country:US
Practice Address - Phone:718-417-9031
Practice Address - Fax:718-417-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0302633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03247023Medicaid
2127072OtherPK