Healthcare Provider Details

I. General information

NPI: 1295659753
Provider Name (Legal Business Name): SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S SALINA ST STE B
SYRACUSE NY
13202-3527
US

IV. Provider business mailing address

819 S SALINA ST STE B
SYRACUSE NY
13202-3527
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PRAVEEN KUMAR CHALLA
Title or Position: OWNER
Credential:
Phone: 718-643-6300