PALACE PHARMACY INC , NPI 1285679480 — PALACE PHARMACY in NEW YORK (NY)

NPI 1285679480

13+ Years Experience Organization

PALACE PHARMACY INC

Other organization name: PALACE PHARMACY. Name type code: 3 - doing business as (d/b/ a) name.

06/19/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1285679480
NPI NUMBER

About PALACE PHARMACY INC

PALACE PHARMACY INC is a provider established in NEW YORK, NY. The NPI number of PALACE PHARMACY INC is 1285679480 and was assigned on 06/19/2006. The practitioners primary taxonomy code is: 333600000X with license number: 27539 NY .

Mailing address

  • City: NEW YORK
  • State: NY
  • Postal code: 100371806
  • Address: 543 MALCOLM X BLVD

Primary Practice Address

  • Region : NEW YORK, NY
  • NPI : 1285679480
  • Phone : 2122832136
  • Fax : 2122832463
  • Postalcode : 100371806
  • Address : 543 MALCOLM X BLVD

Additional identifiers

  • Identifier: 3350814
  • Code / Type : 1 - other
  • Identifier state :
  • Identifier issuer: OTHER ID NUMBER-COMMERCIAL NUMBER

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Pharmacy

  • Taxonomy code: 333600000X
  • License number: 27539
  • License state: NY

The primary taxonomy switch is Not Answered.

Taxonomy description: A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Healthcare provider taxonomy #2 - Pharmacy

  • Taxonomy code: 3336C0003X

The primary taxonomy switch is Not Answered.

Taxonomy description: A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Contacts:

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  • PALACE PHARMACY INC
  • Address : 543 MALCOLM X BLVD
  • Region : NEW YORK, NY
  • NPI : 1285679480
  • Phone : 2122832136
  • Fax : 2122832463
  • Postalcode : 100371806

Authorized official :

{:AUTHORIZED_OFFICIAL_FIRST_NAME:} {:AUTHORIZED_OFFICIAL_MIDDLE_NAME:} {:AUTHORIZED_OFFICIAL_LAST_NAME:}
  • Phone : 9174592518
  • Title or position : PRESIDENT AND SUPV PHCIST
  • Credentials : RPH

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address543 MALCOLM X BLVD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameNEW YORK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNY
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code100371806
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number2122832136
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2122832463
The fax number associated with the location address of the provider being identified.
NPI1285679480
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1333600000X
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Provider Enumeration Date06/19/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeOrganization
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)PALACE PHARMACY INC
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider Other Organization NamePALACE PHARMACY
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address543 MALCOLM X BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameNEW YORK
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameNY
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code100371806
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Authorized Official Last NameMAMDOUG SABRA
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameAHMED
The first name of the authorized official
Authorized Official Title or PositionPRESIDENT AND SUPV PHCIST
The title or position of the authorized official
Authorized Official Credential TextRPH
Authorized Official Credential Text
Authorized Official Telephone Number9174592518
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code #1333600000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
Provider License Number 127539
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1NY
Healthcare Provider Primary Taxonomy Switch 1X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 23336C0003X
Healthcare Provider Taxonomy 2Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Healthcare Provider Primary Taxonomy Switch 2X
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 13350814
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier Issuer 1OTHER ID NUMBER-COMMERCIAL NUMBER
Other Provider Identifier Issuer #1
X

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