Provider Demographics
NPI:1891045126
Name:PHARMACHOICE PHARMACY INC
Entity Type:Organization
Organization Name:PHARMACHOICE PHARMACY INC
Other - Org Name:STEINWAY STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISADA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-738-6443
Mailing Address - Street 1:2578 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3774
Mailing Address - Country:US
Mailing Address - Phone:347-738-6443
Mailing Address - Fax:347-344-6922
Practice Address - Street 1:2578 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3774
Practice Address - Country:US
Practice Address - Phone:347-738-6443
Practice Address - Fax:347-344-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0314733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136904OtherPK
NY03499465Medicaid