Healthcare Provider Details

I. General information

NPI: 1275648693
Provider Name (Legal Business Name): PAKAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 MARCY AVE
BROOKLYN NY
11206-6406
US

IV. Provider business mailing address

597 MARCY AVE
BROOKLYN NY
11206-6406
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-5255
  • Fax: 718-486-7210
Mailing address:
  • Phone: 718-486-5255
  • Fax: 718-486-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number017579
License Number StateNY

VIII. Authorized Official

Name: MR. NAZIR AHMAD
Title or Position: PRESIDENT
Credential: RPH PHARMACIST
Phone: 718-486-5255