Provider Demographics
NPI:1982752531
Name:AVN PHARMACY, INC
Entity type:Organization
Organization Name:AVN PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P
Authorized Official - Prefix:
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-534-1937
Mailing Address - Street 1:2240 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2904
Mailing Address - Country:US
Mailing Address - Phone:212-534-1937
Mailing Address - Fax:212-534-5065
Practice Address - Street 1:2240 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2904
Practice Address - Country:US
Practice Address - Phone:212-534-1937
Practice Address - Fax:212-534-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0223433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01741762Medicaid
NY4905030001Medicare ID - Type UnspecifiedPHARMACY