Healthcare Provider Details

I. General information

NPI: 1407949183
Provider Name (Legal Business Name): PARK IRMAT DRUG CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARK AVE
NEW YORK NY
10016-5675
US

IV. Provider business mailing address

2 PARK AVE
NEW YORK NY
10016-5675
US

V. Phone/Fax

Practice location:
  • Phone: 212-685-0500
  • Fax: 212-532-6596
Mailing address:
  • Phone: 212-685-0500
  • Fax: 212-532-6596

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 Number021645
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JANAKIRAM AJJARAPU
Title or Position: PRESIDENT
Credential:
Phone: 267-888-1001