Provider Demographics
NPI:1912038019
Name:REDI CORPORATION AND PHARMACY
Entity Type:Organization
Organization Name:REDI CORPORATION AND PHARMACY
Other - Org Name:REDI CORPORATION AND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEPKUUOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-988-5805
Mailing Address - Street 1:44 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4118
Mailing Address - Country:US
Mailing Address - Phone:845-988-5805
Mailing Address - Fax:914-988-5872
Practice Address - Street 1:44 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4118
Practice Address - Country:US
Practice Address - Phone:845-988-5805
Practice Address - Fax:914-988-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0245073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02001256Medicaid
3308512OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02001256Medicaid