Provider Demographics
NPI:1336275387
Name:ANIL PHARMACY INC
Entity Type:Organization
Organization Name:ANIL PHARMACY INC
Other - Org Name:KINGSBRIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VENU
Authorized Official - Middle Name:G
Authorized Official - Last Name:MADDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-933-5150
Mailing Address - Street 1:229 E KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4413
Mailing Address - Country:US
Mailing Address - Phone:718-933-5150
Mailing Address - Fax:
Practice Address - Street 1:229 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4413
Practice Address - Country:US
Practice Address - Phone:718-933-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017576183500000X
NY00726018332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00726018Medicaid
NY00726018Medicaid