Provider Demographics
NPI:1972096758
Name:50 OCEANA PHARMACY CORP
Entity type:Organization
Organization Name:50 OCEANA PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHBAZ
Authorized Official - Middle Name:JAVAID
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-463-2226
Mailing Address - Street 1:1100 BUSINESS PKWY STE 190
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5073
Mailing Address - Country:US
Mailing Address - Phone:347-868-6394
Mailing Address - Fax:866-905-8873
Practice Address - Street 1:3211 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:347-868-6394
Practice Address - Fax:866-905-8873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05303535Medicaid