Provider Demographics
NPI:1811539604
Name:WEST NYACK PHARMACY LLC
Entity Type:Organization
Organization Name:WEST NYACK PHARMACY LLC
Other - Org Name:WEST NYACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMGAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:845-244-8050
Mailing Address - Street 1:719 W NYACK RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2240
Mailing Address - Country:US
Mailing Address - Phone:845-244-8050
Mailing Address - Fax:845-244-8051
Practice Address - Street 1:719 W NYACK RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2240
Practice Address - Country:US
Practice Address - Phone:845-480-2957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06323371Medicaid