MEDICARE: PGU PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	033797	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2154282	OTHER		PK

General Provider Information

NPI Number	:	1831416536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PGU PHARMACY INC

Provider Business Mailing Address
First Line	:	1229 FRANKLIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3515
Country	:	US
Telephone Number	:	347-597-7999
Fax Number	:	347-597-7405

Provider Business Practice Location Address
First Line	:	1229 FRANKLIN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3515
Country	:	US
Telephone Number	:	347-597-7999
Fax Number	:	347-597-7405

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST / MANAGER
Name	:	SRINIVASULU THOTA
Credential	:
Telephone Number	:	347-597-7999

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/28/2022

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Directions to “PGU PHARMACY INC ” Practice Location

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