Provider Demographics
NPI:1972685766
Name:AMERIWAY PHARMACY INC
Entity Type:Organization
Organization Name:AMERIWAY PHARMACY INC
Other - Org Name:QUALI MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SINH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-872-5737
Mailing Address - Street 1:2272 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4138
Mailing Address - Country:US
Mailing Address - Phone:718-872-5737
Mailing Address - Fax:718-872-5723
Practice Address - Street 1:2272 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4138
Practice Address - Country:US
Practice Address - Phone:718-872-5737
Practice Address - Fax:718-872-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0279133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2068541OtherPK
NY2849829Medicaid