Healthcare Provider Details

I. General information

NPI: 1013937580
Provider Name (Legal Business Name): JAIBABA LOKNATH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 E 167TH ST
BRONX NY
10456-4009
US

IV. Provider business mailing address

397 E 167TH ST
BRONX NY
10456-4009
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-0853
  • Fax: 718-590-0859
Mailing address:
  • Phone: 718-590-0853
  • Fax: 718-590-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025226
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number025226
License Number StateNY

VIII. Authorized Official

Name: MRS. PARAMITA SAHA
Title or Position: DIRECTOR
Credential:
Phone: 718-590-0853