Organization Active NPI

Pranam Healthcare LLC

  • Community/Retail Pharmacy
  • New York, NY
National Provider Identifier
1376943720
Registry record updated Jun 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
033184 Issued in NY
Legal business name
PRANAM HEALTHCARE LLC
Practice address
1381 Saint Nicholas Ave
New York, NY 10033-4001
Phone
(212) 928-7263
Fax
(917) 521-8307
NPI assigned
Sep 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2016

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

Authorized official

Name
Krunal Vasani, RPHNPI 1225343700
Title
Pharmacy Manager/Pic/Ao
Phone
(212) 928-7263

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 033184 NY Primary

Addresses

Primary practice location

1381 Saint Nicholas Ave
New York, NY 10033-4001

Mailing address

1381 Saint Nicholas Ave
New York, NY 10033-4001
Phone (212) 928-7263

Other identifiers 2

IdentifierTypeStateIssuer
2148092OtherPK
4131279MedicaidNY

Other names 1

  • San Pedro Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150702000326 NY DME Supplier - Pharmacy 2860704962 Practice locations: New York, NY
O20210324002295 NY Part B Supplier - Mass Immunization (Roster Biller Only) 2860704962 Practice locations: New York, NY

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Pranam Healthcare LLC1381 Saint Nicholas Ave, New York, NY 10033-4001(212) 928-7263 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Apr 15, 2015

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1376943720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334001",
            "telephone_number": "212-928-7263",
            "fax_number": "917-521-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334001",
            "telephone_number": "212-928-7263",
            "fax_number": "917-521-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRANAM HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-03",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "VASANI",
        "authorized_official_first_name": "KRUNAL",
        "authorized_official_title_or_position": "PHARMACY MANAGER/PIC/AO",
        "authorized_official_telephone_number": "212-928-7263",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "033184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2148092",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4131279",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Pedro Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; 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.