Organization
KMDS INC
Active
Other names
goodman plaza pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SUDARSANA VARMA UDDARAJU B.S. (SUPERVISING PHARMACIST)
(718) 842-0031
Entity
Organization
Contact information
Practice address
3250 3RD AVE, BRONX, NY 10456-6743
(718) 842-0031
(718) 842-0129
Mailing address
3250 3RD AVE, BRONX, NY 10456-6743
(718) 842-0031
(718) 842-0129
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
025129
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02239169
—
NY
01
—
3379876
PHARMACY NCPDP NUMBER
NY
Enumeration date
10/29/2006
Last updated
10/18/2007
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