Provider Demographics
NPI:1306098595
Name:BROADWAY CHEMISTS INC.
Entity type:Organization
Organization Name:BROADWAY CHEMISTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SEC'Y/TRES.
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDHIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-561-5253
Mailing Address - Street 1:194 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5415
Mailing Address - Country:US
Mailing Address - Phone:845-561-5253
Mailing Address - Fax:845-561-7978
Practice Address - Street 1:194 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5415
Practice Address - Country:US
Practice Address - Phone:845-561-5253
Practice Address - Fax:845-561-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029080333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03032464Medicaid
NY03032464Medicaid