=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366590366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWAMIKRUPA CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 10/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1187 GRAND CONCOURSE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10452-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-293-1072
-----------------------------------------------------
Fax | 718-293-1073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1187 GRAND CONCOURSE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10452-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-293-1072
-----------------------------------------------------
Fax | 718-293-1073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SANJAY PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-293-1072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 025668
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------