Provider Demographics
NPI:1205934833
Name:STAND PHARMACY INC
Entity type:Organization
Organization Name:STAND PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBBAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SEHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-861-5490
Mailing Address - Street 1:1515 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460
Mailing Address - Country:US
Mailing Address - Phone:718-861-5490
Mailing Address - Fax:718-861-5493
Practice Address - Street 1:1515 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:718-861-5490
Practice Address - Fax:718-861-5493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAND PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024530333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3312004OtherNABP NCPOP
NY02054002Medicaid
NY1311940001Medicare NSC