Provider Demographics
NPI:1457780868
Name:ARCADIA HEALTH PHARMACY CORP.
Entity Type:Organization
Organization Name:ARCADIA HEALTH PHARMACY CORP.
Other - Org Name:ARCADIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-886-8263
Mailing Address - Street 1:PO BOX 520922
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0922
Mailing Address - Country:US
Mailing Address - Phone:718-878-6999
Mailing Address - Fax:718-939-8838
Practice Address - Street 1:4235 MAIN ST UNIT 1L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4721
Practice Address - Country:US
Practice Address - Phone:718-878-6999
Practice Address - Fax:718-939-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0323153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142579OtherPK