Provider Demographics
NPI:1265758346
Name:HYDE PARK PHARMACY INC
Entity type:Organization
Organization Name:HYDE PARK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:HAYAT
Authorized Official - Last Name:LODHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-229-5599
Mailing Address - Street 1:870 VIOLET AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1754
Mailing Address - Country:US
Mailing Address - Phone:845-229-5599
Mailing Address - Fax:845-229-5523
Practice Address - Street 1:870 VIOLET AVE STE 10
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1754
Practice Address - Country:US
Practice Address - Phone:845-229-5599
Practice Address - Fax:845-229-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042577333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062780661OtherPERSONNAL #
NY6408260001Medicare NSC