Supreme Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUPREME PHARMACY INC.

Doing business as

Queen Mary Pharmacy
Southern Blvd Pharmacy

Practice address

990 Southern Blvd
Bronx, NY 10459-3402

Phone

(718) 282-2000

Fax

(718) 282-0222

NPI assigned

Dec 4, 2019

Organization subpart

No

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

Authorized official

Name

Krupa Sannidhi

Title

Owner

Phone

(718) 282-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Queen Mary Pharmacy Doing business as
• SOUTHERN BLVD PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY3 enrollments

Enrollment records 3

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

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Satya Prasad Devarasetty

  • Pharmacist
  • Jersey City, NJ
  • NPI 1043538960
  NPD
• Andrew N Hanna

  • Pharmacist
  • Neptune City, NJ
  • NPI 1740959873
  NPD
• Akhil M Thomas, DOCTOR OF PHARMACY

  • Pharmacist
  • Marietta, GA
  • NPI 1992668636
  NPD

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1346887833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593402",
            "telephone_number": "718-282-2000",
            "fax_number": "718-282-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593402",
            "telephone_number": "718-282-2000",
            "fax_number": "718-282-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-04",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "SANNIDHI",
        "authorized_official_first_name": "KRUPA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-282-2000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06075896",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Queen Mary Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHERN BLVD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Superior Dental
• Superior Vision Center
• Supply Needs Co. Corp.
• Alan Supraner, PHD
• Supreme Medical Supplies Inc
• Supreme Vision Center Inc (Fabulous Optical)
• Lirose Supreme-Edouard, BS BEHAVIOR SCIENCE
• Mark Edward Surabian, ABD, ATP
• Riyana Kassim Suraka, RN
• Pallavi Surana

• Community/Retail Pharmacy in Bronx, NY
• Providers in Bronx, 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 Nov 10, 2025; 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.