Provider Demographics
NPI:1972651180
Name:MEDCOURT PHARMACY, INC.
Entity Type:Organization
Organization Name:MEDCOURT PHARMACY, INC.
Other - Org Name:MARAM PHARMACY & SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANJAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-651-0795
Mailing Address - Street 1:7701 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6607
Mailing Address - Country:US
Mailing Address - Phone:718-651-0795
Mailing Address - Fax:718-651-0054
Practice Address - Street 1:7701 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6607
Practice Address - Country:US
Practice Address - Phone:718-651-0795
Practice Address - Fax:718-651-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0175533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3302584OtherNABP NUMBER
NY00728670Medicaid
NY0301230001Medicare NSC