Provider Demographics
NPI:1942283882
Name:SHREE NATH PHARMACY CORP
Entity Type:Organization
Organization Name:SHREE NATH PHARMACY CORP
Other - Org Name:MARIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HASMUKH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:212-795-1795
Mailing Address - Street 1:1576 ST NICHOLAS AVE
Mailing Address - Street 2:SHREE NATH PHARMACY CORP
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040
Mailing Address - Country:US
Mailing Address - Phone:212-795-1795
Mailing Address - Fax:212-740-7868
Practice Address - Street 1:1576 ST NICHOLAS AVE
Practice Address - Street 2:SHREE NATH PHARMACY CORP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040
Practice Address - Country:US
Practice Address - Phone:212-795-1795
Practice Address - Fax:212-740-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01602446Medicaid
NY5397270001Medicare NSC