Provider Demographics
NPI:1588789226
Name:PERSONAL CARE PHARMACY INC.
Entity type:Organization
Organization Name:PERSONAL CARE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:S.P.
Authorized Official - Prefix:
Authorized Official - First Name:TANSIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-282-7375
Mailing Address - Street 1:836 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5310
Mailing Address - Country:US
Mailing Address - Phone:718-282-7375
Mailing Address - Fax:718-282-2731
Practice Address - Street 1:836 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5310
Practice Address - Country:US
Practice Address - Phone:718-282-7375
Practice Address - Fax:718-282-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026919333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595706Medicaid
NY5290370001Medicare ID - Type Unspecified