=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609993823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOTU CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7417 101ST AVE CHOTU PHARMACY
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-296-1023
-----------------------------------------------------
Fax | 718-296-1023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7417 101ST AVE CHOTU PHARMACY
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-296-1023
-----------------------------------------------------
Fax | 718-296-1023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DIWAN CHAND GULATI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-296-1023
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 020850
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------