Provider Demographics
NPI:1700271897
Name:PHARMACENA LABS LLC
Entity Type:Organization
Organization Name:PHARMACENA LABS LLC
Other - Org Name:PHARMACENA LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-315-7740
Mailing Address - Street 1:516 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1716
Mailing Address - Country:US
Mailing Address - Phone:516-209-4970
Mailing Address - Fax:888-315-7741
Practice Address - Street 1:516 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1716
Practice Address - Country:US
Practice Address - Phone:516-209-4970
Practice Address - Fax:888-315-7741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033465333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151288OtherPK