Healthcare Provider Details

I. General information

NPI: 1295181618
Provider Name (Legal Business Name): PHARMA HOLDINGS US OF NY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 3RD AVE 10TH FL, SUITE 1000
BROOKLYN NY
11232-1904
US

IV. Provider business mailing address

882 3RD AVE 10TH FL, SUITE 1000
BROOKLYN NY
11232-1904
US

V. Phone/Fax

Practice location:
  • Phone: 718-887-9955
  • Fax: 718-887-9558
Mailing address:
  • Phone: 718-887-9955
  • Fax: 718-887-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number033979
License Number StateNY

VIII. Authorized Official

Name: NIZAR ALIKHAN
Title or Position: CREDENTIALING CONTACT
Credential:
Phone: 214-888-8099