Provider Demographics
NPI:1063738789
Name:HYDE PARK PHARMACY INC.
Entity type:Organization
Organization Name:HYDE PARK PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUP PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:HAYAT
Authorized Official - Last Name:LODHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-229-5599
Mailing Address - Street 1:870 VIOLET AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1754
Mailing Address - Country:US
Mailing Address - Phone:845-229-5599
Mailing Address - Fax:845-229-5523
Practice Address - Street 1:870 VIOLET AVE STE 10
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1754
Practice Address - Country:US
Practice Address - Phone:845-229-5599
Practice Address - Fax:845-229-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0425773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherPERSONNAL