Provider Demographics
NPI:1104635846
Name:PHARMACY ON THE PARK CORPORATION
Entity type:Organization
Organization Name:PHARMACY ON THE PARK CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-860-0939
Mailing Address - Street 1:1674 PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4785
Mailing Address - Country:US
Mailing Address - Phone:212-860-0939
Mailing Address - Fax:
Practice Address - Street 1:1674 PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4785
Practice Address - Country:US
Practice Address - Phone:212-860-0939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy