Provider Demographics
NPI:1194814889
Name:CAMY PHARMACY INC
Entity type:Organization
Organization Name:CAMY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SP
Authorized Official - Prefix:
Authorized Official - First Name:VYOMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-4452
Mailing Address - Street 1:14410 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2232
Mailing Address - Country:US
Mailing Address - Phone:718-461-4452
Mailing Address - Fax:718-461-9899
Practice Address - Street 1:14410 45TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2232
Practice Address - Country:US
Practice Address - Phone:718-461-4452
Practice Address - Fax:718-461-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0222063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02641096Medicaid
2059747OtherPK
0928350001Medicare NSC