Provider Demographics
NPI:1205165842
Name:CORBY PHARMA INC
Entity type:Organization
Organization Name:CORBY PHARMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER / PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ABHIJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDIVADA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-755-6632
Mailing Address - Street 1:988 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4150
Mailing Address - Country:US
Mailing Address - Phone:212-755-6632
Mailing Address - Fax:212-752-4931
Practice Address - Street 1:988 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4150
Practice Address - Country:US
Practice Address - Phone:212-755-6632
Practice Address - Fax:212-752-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03198776Medicaid
NY030135OtherSTATE BOARD
NY5800239OtherNCPDP
NY030135OtherSTATE BOARD
NY03198776Medicaid