Provider Demographics
NPI:1871269928
Name:MEDLINE PLUS PHARMACY INC
Entity Type:Organization
Organization Name:MEDLINE PLUS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-263-1618
Mailing Address - Street 1:166 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2342
Mailing Address - Country:US
Mailing Address - Phone:516-263-1618
Mailing Address - Fax:
Practice Address - Street 1:444 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6061
Practice Address - Country:US
Practice Address - Phone:518-406-7573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy