Provider Demographics
NPI:1215973763
Name:EQUAL CARE US INC
Entity type:Organization
Organization Name:EQUAL CARE US INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HO MING
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-321-7117
Mailing Address - Street 1:13342 39TH AVE UNIT 208
Mailing Address - Street 2:ONE FULTON SQ.
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4515
Mailing Address - Country:US
Mailing Address - Phone:718-321-7117
Mailing Address - Fax:718-321-0375
Practice Address - Street 1:13342 39TH AVE UNIT 208
Practice Address - Street 2:ONE FULTON SQ.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4515
Practice Address - Country:US
Practice Address - Phone:718-321-7117
Practice Address - Fax:718-321-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0003X
NY0266303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02544190Medicaid
2062652OtherPK
5124070001Medicare NSC