Healthcare Provider Details

I. General information

NPI: 1447594429
Provider Name (Legal Business Name): PRAMUKH DRUGS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6562 MYRTLE AVENUE
GLENDALE NY
11385
US

IV. Provider business mailing address

6562 MYRTLE AVENUE
GLENDALE NY
11385
US

V. Phone/Fax

Practice location:
  • Phone: 347-227-8188
  • Fax: 347-227-8402
Mailing address:
  • Phone: 347-227-8188
  • Fax: 347-227-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031692
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA M AVILA
Title or Position: PRESIDENT-OWNER
Credential:
Phone: 347-227-8188