Provider Demographics
NPI:1669579298
Name:MORNINGSIDE PHARMACY,INC
Entity type:Organization
Organization Name:MORNINGSIDE PHARMACY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOONDUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-662-0220
Mailing Address - Street 1:3181 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3303
Mailing Address - Country:US
Mailing Address - Phone:212-662-0220
Mailing Address - Fax:212-749-5555
Practice Address - Street 1:3181 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3303
Practice Address - Country:US
Practice Address - Phone:212-662-0220
Practice Address - Fax:212-749-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00486282Medicaid
3904390001Medicare NSC