Provider Demographics
NPI:1932477973
Name:NAZAHA PHARMACY INC
Entity Type:Organization
Organization Name:NAZAHA PHARMACY INC
Other - Org Name:PENN SUTTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-346-9512
Mailing Address - Street 1:291 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4198
Mailing Address - Country:US
Mailing Address - Phone:718-346-9512
Mailing Address - Fax:718-346-7059
Practice Address - Street 1:291 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4198
Practice Address - Country:US
Practice Address - Phone:718-346-9512
Practice Address - Fax:718-346-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0311363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5804693OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03410120Medicaid
5804693OtherNCPDP PROVIDER IDENTIFICATION NUMBER