Provider Demographics
NPI:1427174101
Name:CASTLE PHARMACY & SURGICAL
Entity type:Organization
Organization Name:CASTLE PHARMACY & SURGICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVOISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-417-4600
Mailing Address - Street 1:6617 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7081
Mailing Address - Country:US
Mailing Address - Phone:718-417-4600
Mailing Address - Fax:
Practice Address - Street 1:6617 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7081
Practice Address - Country:US
Practice Address - Phone:718-417-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491207Medicaid
NY5073930001Medicare ID - Type Unspecified