Provider Demographics
NPI:1932414661
Name:OK PHARMACY & SURGICAL
Entity type:Organization
Organization Name:OK PHARMACY & SURGICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPIC/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-934-0803
Mailing Address - Street 1:3404 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3053
Mailing Address - Country:US
Mailing Address - Phone:718-886-2227
Mailing Address - Fax:718-886-2212
Practice Address - Street 1:3404 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3053
Practice Address - Country:US
Practice Address - Phone:718-886-2227
Practice Address - Fax:718-886-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3290737Medicaid
2126377OtherPK