Provider Demographics
NPI:1962779074
Name:PAPAS PHARMACY
Entity type:Organization
Organization Name:PAPAS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PAPA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADJEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-947-9500
Mailing Address - Street 1:3979 LACONIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:347-947-9500
Mailing Address - Fax:347-947-9502
Practice Address - Street 1:3979 LACONIA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4916
Practice Address - Country:US
Practice Address - Phone:347-947-9500
Practice Address - Fax:347-947-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0310923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133315OtherPK
NY03423989Medicaid
2133315OtherPK