Provider Demographics
NPI:1528136322
Name:CROSS COUNTY PHARMACY INC
Entity type:Organization
Organization Name:CROSS COUNTY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHRMCST
Authorized Official - Prefix:
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-360-6969
Mailing Address - Street 1:1514 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4554
Mailing Address - Country:US
Mailing Address - Phone:212-360-6969
Mailing Address - Fax:212-410-2099
Practice Address - Street 1:1514 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4554
Practice Address - Country:US
Practice Address - Phone:212-360-6969
Practice Address - Fax:212-410-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0187653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3384942OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY00927564Medicaid