Provider Demographics
NPI:1811224660
Name:NUEVA VIDA PHARMACY INC
Entity Type:Organization
Organization Name:NUEVA VIDA PHARMACY INC
Other - Org Name:NUEVA VIDA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-899-0200
Mailing Address - Street 1:8125 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6718
Mailing Address - Country:US
Mailing Address - Phone:718-899-0200
Mailing Address - Fax:718-899-0600
Practice Address - Street 1:8125 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-899-0200
Practice Address - Fax:718-899-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3169211Medicaid
3363277OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY3169211Medicaid