Organization
GOLD STREET PHARMA INC
Active
Other names
Nick's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAVI CHENNA (PRESIDENT)
(718) 855-1990
Entity
Organization
Contact information
Practice address
111 GOLD ST, BROOKLYN, NY 11201-1551
(718) 855-1990
(718) 855-1995
Mailing address
111 GOLD ST, BROOKLYN, NY 11201-1551
(718) 855-1990
(718) 855-1995
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030409
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2128748
PK
—
05
—
3261709
—
NY
Enumeration date
08/03/2010
Last updated
04/21/2017
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