Provider Demographics
NPI:1841640653
Name:UPTOWN CARE PHARMACY LLC
Entity type:Organization
Organization Name:UPTOWN CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-221-8355
Mailing Address - Street 1:2254 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2268
Mailing Address - Country:US
Mailing Address - Phone:212-221-8355
Mailing Address - Fax:917-675-7703
Practice Address - Street 1:2254 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2268
Practice Address - Country:US
Practice Address - Phone:212-221-8355
Practice Address - Fax:917-675-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0345633336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160647OtherPK
NY04552232Medicaid
NY04552232Medicaid