Healthcare Provider Details

I. General information

NPI: 1487042701
Provider Name (Legal Business Name): PHARMACY SPECIALIST GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CRYSTAL ST
BROOKLYN NY
11208-2624
US

IV. Provider business mailing address

155 CRYSTAL ST
BROOKLYN NY
11208-2624
US

V. Phone/Fax

Practice location:
  • Phone: 732-857-7227
  • Fax:
Mailing address:
  • Phone: 732-321-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAISATISH GUNDA
Title or Position: OFFICER
Credential:
Phone: 732-321-4015