Provider Demographics
NPI:1104167253
Name:CB PHARMACY INC
Entity type:Organization
Organization Name:CB PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHIRANJIVI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-673-0044
Mailing Address - Street 1:5216 MILFORD RD
Mailing Address - Street 2:SUIT # 118
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-8347
Mailing Address - Country:US
Mailing Address - Phone:570-431-4994
Mailing Address - Fax:570-431-4944
Practice Address - Street 1:5216 MILFORD RD
Practice Address - Street 2:SUIT # 118
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-8347
Practice Address - Country:US
Practice Address - Phone:570-431-4994
Practice Address - Fax:570-431-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4823003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139406OtherPK