Provider Demographics
NPI:1972631638
Name:CITY CARE PHARMACY INC
Entity Type:Organization
Organization Name:CITY CARE PHARMACY INC
Other - Org Name:RAVENSVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TORIBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-729-5199
Mailing Address - Street 1:3449 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4721
Mailing Address - Country:US
Mailing Address - Phone:718-729-5199
Mailing Address - Fax:718-729-8845
Practice Address - Street 1:3449 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4721
Practice Address - Country:US
Practice Address - Phone:718-729-5199
Practice Address - Fax:718-729-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NY0152663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00275003Medicaid
3318210OtherNCPDP PROVIDER IDENTIFICATION NUMBER