Gold Street Pharma Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

030409 Issued in NY

Legal business name

GOLD STREET PHARMA INC

Doing business as

Nick's Pharmacy

Practice address

111 Gold St
Brooklyn, NY 11201-1551

Phone

(718) 855-1990

Fax

(718) 855-1995

NPI assigned

Aug 3, 2010

Organization subpart

No

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

Authorized official

Name

Ravi Chenna

Title

President

Phone

(718) 855-1990

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Nick's Pharmacy Doing business as

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

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1225342165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GOLD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011551",
            "telephone_number": "718-855-1990",
            "fax_number": "718-855-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GOLD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011551",
            "telephone_number": "718-855-1990",
            "fax_number": "718-855-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD STREET PHARMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "CHENNA",
        "authorized_official_first_name": "RAVI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-855-1990"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "030409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2128748",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3261709",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nick's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Viktoriya Golbraykh, NP
• Gold & Silver Aging Home Care Inc
• Henchie Gold Friedman
• Leah Gold Rapps, L.C.S.W.
• Gold St Pharmacy Corp
• Shakirat Ajoke Gold-Olufadi
• Adina Bracha Gold, OTR/L
• Aleksandra Gold, LCSW
• Ariella Gold
• Brocha Gold, DPT

• Community/Retail Pharmacy in Brooklyn, NY
• Providers in Brooklyn, 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 Apr 21, 2017; 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.