Organization
SHAN PHARMACY INC
Active
Other names
SUMNER AVE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RUKMIN PERSAND (MANAGER AND OWNER)
(718) 455-7100
Entity
Organization
Contact information
Practice address
103 SUMNER AVE, BROOKLYN, NY 11206-6940
(718) 455-7100
(718) 789-8581
Mailing address
103 SUMNER AVE, BROOKLYN, NY 11206-6940
(718) 455-7100
(718) 789-8581
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
023189
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01706216
—
NY
01
—
3397797
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/08/2007
Last updated
05/20/2010
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