Provider Demographics
NPI:1972671550
Name:TRIPHARM DRUG INC
Entity Type:Organization
Organization Name:TRIPHARM DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-816-1116
Mailing Address - Street 1:200 PORT RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302
Mailing Address - Country:US
Mailing Address - Phone:718-816-1116
Mailing Address - Fax:718-816-1116
Practice Address - Street 1:200 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-816-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018702333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3384423OtherNABP
NY00901762Medicaid
3384423OtherNABP