Provider Demographics
NPI:1699780098
Name:CHARMAR INC
Entity type:Organization
Organization Name:CHARMAR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-822-1348
Mailing Address - Street 1:2253 3RD AVE
Mailing Address - Street 2:3RD FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2206
Mailing Address - Country:US
Mailing Address - Phone:212-289-1821
Mailing Address - Fax:212-289-9470
Practice Address - Street 1:2253 3RD AVE
Practice Address - Street 2:3RD FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2206
Practice Address - Country:US
Practice Address - Phone:212-289-1821
Practice Address - Fax:212-289-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0190853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974910Medicaid
NY1091490002Medicare NSC