Provider Demographics
NPI:1912306739
Name:UNICORN PHARMACY INC
Entity Type:Organization
Organization Name:UNICORN PHARMACY INC
Other - Org Name:PLANET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKUOKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-220-2035
Mailing Address - Street 1:2336A GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6903
Mailing Address - Country:US
Mailing Address - Phone:718-220-2035
Mailing Address - Fax:718-220-2826
Practice Address - Street 1:2336A GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6903
Practice Address - Country:US
Practice Address - Phone:718-220-2035
Practice Address - Fax:718-220-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0331183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149243OtherPK
NY04079998Medicaid