Provider Demographics
NPI:1184709479
Name:PHARMORE DRUGS INC
Entity type:Organization
Organization Name:PHARMORE DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V.PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMKHEHJI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-282-3600
Mailing Address - Street 1:510 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2935
Mailing Address - Country:US
Mailing Address - Phone:718-282-3600
Mailing Address - Fax:718-282-7066
Practice Address - Street 1:510 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2935
Practice Address - Country:US
Practice Address - Phone:718-282-3600
Practice Address - Fax:718-282-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
NY0267983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581771Medicaid
2063062OtherPK
NY02581771Medicaid