Healthcare Provider Details

I. General information

NPI: 1730214164
Provider Name (Legal Business Name): KANNAYYA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2558 GRAND CONCOURSE
BRONX NY
10458-4903
US

IV. Provider business mailing address

2558 GRAND CONCOURSE
BRONX NY
10458-4903
US

V. Phone/Fax

Practice location:
  • Phone: 718-364-7070
  • Fax:
Mailing address:
  • Phone: 718-364-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023262
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01902987
License Number StateNY

VIII. Authorized Official

Name: MR. VENU G MADDUKURI
Title or Position: PHARMACIST,OWNER
Credential:
Phone: 718-364-7070