Provider Demographics
NPI:1942449079
Name:VAIDYAM INC
Entity Type:Organization
Organization Name:VAIDYAM INC
Other - Org Name:WELL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACHARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-673-1271
Mailing Address - Street 1:4283 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4721
Mailing Address - Country:US
Mailing Address - Phone:718-353-1350
Mailing Address - Fax:718-353-1981
Practice Address - Street 1:4283 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4721
Practice Address - Country:US
Practice Address - Phone:718-353-1350
Practice Address - Fax:718-353-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0292983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119134OtherPK
NY3081629Medicaid
NY6223440001Medicare NSC