Provider Demographics
NPI:1942609904
Name:BOSTON PHARMA LLC
Entity Type:Organization
Organization Name:BOSTON PHARMA LLC
Other - Org Name:ABO PHARMACY & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANGA SANTOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:NARLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-872-5142
Mailing Address - Street 1:8003 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3533
Mailing Address - Country:US
Mailing Address - Phone:718-872-5142
Mailing Address - Fax:718-872-5137
Practice Address - Street 1:8003 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3533
Practice Address - Country:US
Practice Address - Phone:718-872-5142
Practice Address - Fax:718-872-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0342643336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04428722Medicaid
2148253OtherPK