Provider Demographics
NPI:1366510505
Name:V & K PHARMACY INC
Entity type:Organization
Organization Name:V & K PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-293-8777
Mailing Address - Street 1:1227 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3500
Mailing Address - Country:US
Mailing Address - Phone:718-293-8777
Mailing Address - Fax:718-992-1211
Practice Address - Street 1:1227 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3500
Practice Address - Country:US
Practice Address - Phone:718-293-8777
Practice Address - Fax:718-992-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0195883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01040284Medicaid
3390818OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01040284Medicaid