Provider Demographics
NPI:1720099377
Name:POLSAK CORPORATION
Entity Type:Organization
Organization Name:POLSAK CORPORATION
Other - Org Name:R AND S PIONEER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRMD
Authorized Official - Prefix:
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-538-8183
Mailing Address - Street 1:1018 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-5103
Mailing Address - Country:US
Mailing Address - Phone:718-538-8183
Mailing Address - Fax:718-538-2855
Practice Address - Street 1:1018 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5103
Practice Address - Country:US
Practice Address - Phone:718-538-8183
Practice Address - Fax:718-538-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0282623336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2843841Medicaid
2058490OtherPK
3306190OtherOTHER ID NUMBER-COMMERCIAL NUMBER