Provider Demographics
NPI:1225848781
Name:MODERN PHARMACY INCORPORATED
Entity type:Organization
Organization Name:MODERN PHARMACY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAGATA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-282-7660
Mailing Address - Street 1:9502 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1638
Mailing Address - Country:US
Mailing Address - Phone:888-585-6874
Mailing Address - Fax:
Practice Address - Street 1:9502 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1638
Practice Address - Country:US
Practice Address - Phone:888-585-6874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy