MEDICARE: PRAYOSHA PHARMACY CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	026460	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	026460	OTHER	NY	STATE PHARMACY LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023114386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAYOSHA PHARMACY CORP.

Provider Business Mailing Address
First Line	:	54 E 183RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-1239
Country	:	US
Telephone Number	:	718-220-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 E 183RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-1239
Country	:	US
Telephone Number	:	718-220-1900
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. PANKAJ R PATEL
Credential	:	BS PHARM
Telephone Number	:	718-220-7900

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	02/08/2008

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