Provider Demographics
NPI:1902268162
Name:103 PHARMACY INC
Entity Type:Organization
Organization Name:103 PHARMACY INC
Other - Org Name:103 PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-410-4410
Mailing Address - Street 1:2002 2ND AVE
Mailing Address - Street 2:STORE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5445
Mailing Address - Country:US
Mailing Address - Phone:212-410-4410
Mailing Address - Fax:212-410-4414
Practice Address - Street 1:2002 2ND AVE
Practice Address - Street 2:STORE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5445
Practice Address - Country:US
Practice Address - Phone:212-410-4410
Practice Address - Fax:212-410-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034593333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160834OtherPK