Provider Demographics
NPI:1922456607
Name:BANGLA PHARMACY INC
Entity Type:Organization
Organization Name:BANGLA PHARMACY INC
Other - Org Name:BANGLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABED
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-554-1900
Mailing Address - Street 1:401 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3107
Mailing Address - Country:US
Mailing Address - Phone:718-554-1900
Mailing Address - Fax:718-496-6014
Practice Address - Street 1:401 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3107
Practice Address - Country:US
Practice Address - Phone:718-554-1900
Practice Address - Fax:718-496-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0342673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04568058Medicaid
2160475OtherPK