Provider Demographics
NPI:1750416699
Name:MEDICINE CENTER INC.
Entity type:Organization
Organization Name:MEDICINE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHYAMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-410-2814
Mailing Address - Street 1:92 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8203
Mailing Address - Country:US
Mailing Address - Phone:718-410-2814
Mailing Address - Fax:718-410-2815
Practice Address - Street 1:92 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8203
Practice Address - Country:US
Practice Address - Phone:718-410-2814
Practice Address - Fax:718-410-2815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0241463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024146OtherPHARMACY REGISTRATION NUM
NY01905004Medicaid