Healthcare Provider Details

I. General information

NPI: 1730211491
Provider Name (Legal Business Name): MIRAJ PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 FULTON AVE
HEMPSTEAD NY
11550-3908
US

IV. Provider business mailing address

362 FULTON AVE
HEMPSTEAD NY
11550-3908
US

V. Phone/Fax

Practice location:
  • Phone: 516-489-9500
  • Fax: 516-489-9501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number023038
License Number StateNY

VIII. Authorized Official

Name: MADHU SHARMA
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 516-489-9500