Provider Demographics
NPI:1821142324
Name:SRUTHI AND SWAROOP PHARMACY INC
Entity Type:Organization
Organization Name:SRUTHI AND SWAROOP PHARMACY INC
Other - Org Name:RUTLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:P
Authorized Official - Last Name:AKKINENI
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARMACY
Authorized Official - Phone:718-774-9613
Mailing Address - Street 1:964 RUTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1544
Mailing Address - Country:US
Mailing Address - Phone:718-774-9613
Mailing Address - Fax:
Practice Address - Street 1:964 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1544
Practice Address - Country:US
Practice Address - Phone:718-774-9613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0226893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01598961Medicaid
NY5117360001Medicare ID - Type Unspecified