Healthcare Provider Details

I. General information

NPI: 1376502187
Provider Name (Legal Business Name): 2000 NINOS PHARMACY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 150TH ST
NEW YORK NY
10031-2449
US

IV. Provider business mailing address

3663 BROADWAY
NEW YORK NY
10031-2449
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-2910
  • Fax: 212-491-9996
Mailing address:
  • Phone: 212-491-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022880
License Number StateNY

VIII. Authorized Official

Name: MANICKARAJAN PILLAY
Title or Position: PRESIDENT
Credential: RPH
Phone: 212-491-2910