Provider Demographics
NPI:1265813620
Name:520 FRANKLIN AVENUE PHARMACY
Entity type:Organization
Organization Name:520 FRANKLIN AVENUE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANAKIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AJJARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:267-888-1001
Mailing Address - Street 1:520 FRANKLIN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5814
Mailing Address - Country:US
Mailing Address - Phone:516-280-7960
Mailing Address - Fax:516-280-7962
Practice Address - Street 1:520 FRANKLIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5814
Practice Address - Country:US
Practice Address - Phone:516-280-7960
Practice Address - Fax:516-280-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0337603336C0003X
NY0527553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04411267Medicaid
2167960OtherPK
7474450001Medicare NSC