Provider Demographics
NPI:1932556032
Name:MAIN STREET PHARMACY INC
Entity Type:Organization
Organization Name:MAIN STREET PHARMACY INC
Other - Org Name:MAIN STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-235-1000
Mailing Address - Street 1:761 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1511
Mailing Address - Country:US
Mailing Address - Phone:914-235-1000
Mailing Address - Fax:914-235-1001
Practice Address - Street 1:761 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1511
Practice Address - Country:US
Practice Address - Phone:914-235-1000
Practice Address - Fax:914-235-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0345143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160219OtherPK
2160219OtherPK