Provider Demographics
NPI:1902044670
Name:M & D PHARMACY LLC
Entity Type:Organization
Organization Name:M & D PHARMACY LLC
Other - Org Name:HARLEM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ATULKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-831-0200
Mailing Address - Street 1:17 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4513
Mailing Address - Country:US
Mailing Address - Phone:212-831-0200
Mailing Address - Fax:212-831-0230
Practice Address - Street 1:17 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4513
Practice Address - Country:US
Practice Address - Phone:212-831-0200
Practice Address - Fax:212-831-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3125739Medicaid
3364534OtherNCPDP PROVIDER IDENTIFICATION NUMBER