Provider Demographics
NPI:1952466120
Name:PRANAYA PHARMACY INC
Entity Type:Organization
Organization Name:PRANAYA PHARMACY INC
Other - Org Name:KEANES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SREENIVASA REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GADE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-368-3777
Mailing Address - Street 1:586 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1201
Mailing Address - Country:US
Mailing Address - Phone:212-368-3777
Mailing Address - Fax:212-368-3778
Practice Address - Street 1:586 LENOX AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1201
Practice Address - Country:US
Practice Address - Phone:212-368-3777
Practice Address - Fax:212-368-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0246803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02045201Medicaid
NY02045201Medicaid