| NPI | 1780052001 |
|---|---|
| Doing Business As | 112 PHARMACY & SURGICAL |
| Entity Type | Organization |
| Authorized Contact | RAJENDRAPRASAD VENIGALLA Secretary 347-528-8893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 033702) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336L0003X Pharmacy, Long Term Care Pharmacy | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2021-01-27 |