139 Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

139 PHARMACY, INC.

Practice address

3411 Broadway
New York, NY 10031-7407

Phone

(212) 283-5764

Fax

(212) 283-5764

NPI assigned

Jan 29, 2007

Last updated

Aug 23, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

139 PHARMACY, INC.As reported in NPPES

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

Authorized official

Name

Mr. Vinay WalterNPI 1396997409

Title

RPH

Phone

(212) 283-6623

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Part of

139 Pharmacy Inc

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vinay Walter, RPH

  • Pharmacist
  • New York, NY
  • NPI 1396997409
  NPD Authorized official
• Varghese K Thomas, RPH

  • Pharmacist
  • New York, NY
  • NPI 1144472358
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1194861104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3411 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100317407",
            "telephone_number": "212-283-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3411 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100317407",
            "telephone_number": "212-283-5764",
            "fax_number": "212-283-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "139 PHARMACY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "139 PHARMACY, INC.",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "WALTER",
        "authorized_official_first_name": "VINAY",
        "authorized_official_title_or_position": "RPH",
        "authorized_official_telephone_number": "212-283-6623",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "015978",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01423894",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3337373",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in New York, NY
• Providers in New York, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.