Provider Demographics
NPI:1649907940
Name:SHAFA PHARMACY LLC
Entity type:Organization
Organization Name:SHAFA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KOOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-730-8990
Mailing Address - Street 1:621 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1245
Mailing Address - Country:US
Mailing Address - Phone:516-730-8990
Mailing Address - Fax:516-730-8968
Practice Address - Street 1:621 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1245
Practice Address - Country:US
Practice Address - Phone:516-730-8990
Practice Address - Fax:516-730-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy