Provider Demographics
NPI:1528312238
Name:GOMES, ASHOKA BENEDICT (BS, MS, PHARMD)
Entity type:Individual
Prefix:MR
First Name:ASHOKA
Middle Name:BENEDICT
Last Name:GOMES
Suffix:
Gender:M
Credentials:BS, MS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10831
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-0831
Mailing Address - Country:US
Mailing Address - Phone:917-446-2884
Mailing Address - Fax:
Practice Address - Street 1:9401, #7, 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1137
Practice Address - Country:US
Practice Address - Phone:347-699-1237
Practice Address - Fax:347-699-1237
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05465132Medicaid