NPIMap

Organization Active NPI

Syracuse Community Health Pharmacy LLC

  • Community/Retail Pharmacy
  • Syracuse, NY
National Provider Identifier
1043871775
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SYRACUSE COMMUNITY HEALTH PHARMACY LLC
Practice address
819 S Salina St Ste B
Syracuse, NY 13202-3527
Phone
(315) 515-5839
Fax
(315) 295-2750
NPI assigned
Jun 24, 2019
Last updated
Feb 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Praveen Kumar Challa
Title
Member
Phone
(863) 602-0499

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

819 S Salina St Ste B
Syracuse, NY 13202-3527

Mailing address

819 S Salina St Ste B
Syracuse, NY 13202-3527
Phone (315) 515-5839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200306002288 NY DME Supplier - Pharmacy 6901234830 Practice locations: Syracuse, NY
O20220614000722 NY Part B Supplier - Mass Immunization (Roster Biller Only) 6901234830 Practice locations: Syracuse, NY

National Provider Directory

National Provider Directory
Tax ID family
Syracuse Community Health Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 7

Organizations this organization is a member of, according to the National Provider Directory.

Locations

819 S Salina St
Ste B
Syracuse, NY 13202
Phone (315) 515-5839

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1043871775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 S SALINA ST STE B",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023527",
            "telephone_number": "315-515-5839",
            "fax_number": "315-295-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 S SALINA ST STE B",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023527",
            "telephone_number": "315-515-5839",
            "fax_number": "315-295-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYRACUSE COMMUNITY HEALTH PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "CHALLA",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "863-602-0499",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.