Provider Demographics
NPI:1932352408
Name:RISTA PHARMACY CORP.
Entity type:Organization
Organization Name:RISTA PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHANI
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:718-658-9300
Mailing Address - Street 1:8342 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1642
Mailing Address - Country:US
Mailing Address - Phone:718-658-9300
Mailing Address - Fax:718-658-2700
Practice Address - Street 1:8342 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1642
Practice Address - Country:US
Practice Address - Phone:718-658-9300
Practice Address - Fax:718-658-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0291233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029123OtherBOARD OF PHARMACY LICENSE NUMBER
6172350001Medicare NSC