Provider Demographics
NPI:1902157019
Name:EAST HARLEM PHARMACY CORP
Entity Type:Organization
Organization Name:EAST HARLEM PHARMACY CORP
Other - Org Name:ABC DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-491-2501
Mailing Address - Street 1:2095 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3449
Mailing Address - Country:US
Mailing Address - Phone:212-491-2501
Mailing Address - Fax:212-491-2502
Practice Address - Street 1:2095 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3449
Practice Address - Country:US
Practice Address - Phone:212-491-2501
Practice Address - Fax:212-491-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0315063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137168OtherPK
NY3528934Medicaid