Provider Demographics
NPI:1457581142
Name:MR PHARMACY INC
Entity Type:Organization
Organization Name:MR PHARMACY INC
Other - Org Name:IDEAL DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYANK
Authorized Official - Middle Name:
Authorized Official - Last Name:JARMARWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-868-4860
Mailing Address - Street 1:1901 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4104
Mailing Address - Country:US
Mailing Address - Phone:718-868-4860
Mailing Address - Fax:718-327-2543
Practice Address - Street 1:1901 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4104
Practice Address - Country:US
Practice Address - Phone:718-868-4860
Practice Address - Fax:718-327-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0295273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3125142Medicaid
2121278OtherPK