Provider Demographics
NPI:1962721241
Name:GRAND HEALTH PHARMACY INC
Entity type:Organization
Organization Name:GRAND HEALTH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-228-0068
Mailing Address - Street 1:349 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4628
Mailing Address - Country:US
Mailing Address - Phone:212-228-0068
Mailing Address - Fax:212-228-9668
Practice Address - Street 1:349 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4628
Practice Address - Country:US
Practice Address - Phone:212-228-0068
Practice Address - Fax:212-228-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3271670Medicaid
NY6460500001Medicare NSC