Healthcare Provider Details

I. General information

NPI: 1578834321
Provider Name (Legal Business Name): BARAKA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 WHITE PLAINS RD
BRONX NY
10462-1412
US

IV. Provider business mailing address

2088 WHITE PLAINS RD
BRONX NY
10462-1412
US

V. Phone/Fax

Practice location:
  • Phone: 347-691-3333
  • Fax: 347-691-3332
Mailing address:
  • Phone: 347-691-3333
  • Fax: 347-691-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030997
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED ELADMA
Title or Position: OWNER
Credential:
Phone: 347-691-3333