Provider Demographics
NPI:1700157484
Name:ARCHI-MED PHARMACY INC.
Entity type:Organization
Organization Name:ARCHI-MED PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGARNIK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-333-1215
Mailing Address - Street 1:6 BAY 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6917
Mailing Address - Country:US
Mailing Address - Phone:718-333-1215
Mailing Address - Fax:718-333-1217
Practice Address - Street 1:6 BAY 50TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6917
Practice Address - Country:US
Practice Address - Phone:718-333-1215
Practice Address - Fax:718-333-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0310643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03424013Medicaid
NY6683750001Medicare NSC