Provider Demographics
NPI:1255802153
Name:REALVALUE PATIENTS PHARMACY INC
Entity type:Organization
Organization Name:REALVALUE PATIENTS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DOCTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOKA
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS, PHARMD
Authorized Official - Phone:347-699-1237
Mailing Address - Street 1:9401 37TH AVE # 7
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7917
Mailing Address - Country:US
Mailing Address - Phone:347-699-1237
Mailing Address - Fax:
Practice Address - Street 1:9401 37TH AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7917
Practice Address - Country:US
Practice Address - Phone:347-699-1237
Practice Address - Fax:347-699-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05493476Medicaid