Provider Demographics
NPI:1144507385
Name:BGH RX INC
Entity type:Organization
Organization Name:BGH RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BALAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDDUKURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-964-1000
Mailing Address - Street 1:1155-A BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208
Mailing Address - Country:US
Mailing Address - Phone:718-964-1000
Mailing Address - Fax:
Practice Address - Street 1:1155 A BLAKE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-964-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0309523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030952OtherBOARD OF PHARMACY REGISTRATION
NY030952OtherBOARD OF PHARMACY REGISTRATION