Provider Demographics
NPI:1952589251
Name:MEDICMASTERS PHARMACY & SURGICAL SUPPLIES INC
Entity Type:Organization
Organization Name:MEDICMASTERS PHARMACY & SURGICAL SUPPLIES INC
Other - Org Name:MEDICMASTERS PHARMACY AND SURGICAL SUPPLIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KAVEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-206-4121
Mailing Address - Street 1:16926 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5286
Mailing Address - Country:US
Mailing Address - Phone:718-206-4121
Mailing Address - Fax:718-206-4126
Practice Address - Street 1:16926 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5286
Practice Address - Country:US
Practice Address - Phone:718-206-4121
Practice Address - Fax:718-206-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0287343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02960209Medicaid
NY02960209Medicaid
NY02960209Medicaid