Healthcare Provider Details

I. General information

NPI: 1487907697
Provider Name (Legal Business Name): SRK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 OGDEN AVE
BRONX NY
10452-3500
US

IV. Provider business mailing address

1227 OGDEN AVE
BRONX NY
10452-3500
US

V. Phone/Fax

Practice location:
  • Phone: 718-293-8777
  • Fax: 718-992-1211
Mailing address:
  • Phone: 718-293-8777
  • Fax: 718-992-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031753
License Number StateNY

VIII. Authorized Official

Name: SRINIVASA R KOLLI
Title or Position: PRESIDENT
Credential:
Phone: 718-293-8777