Provider Demographics
NPI:1669728036
Name:SAI APTEKA PHARMACY INC
Entity type:Organization
Organization Name:SAI APTEKA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SRIHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-349-8989
Mailing Address - Street 1:151 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4023
Mailing Address - Country:US
Mailing Address - Phone:718-349-8989
Mailing Address - Fax:718-348-3949
Practice Address - Street 1:151 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4023
Practice Address - Country:US
Practice Address - Phone:718-349-8989
Practice Address - Fax:718-348-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0314003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5805722OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03490324Medicaid