Pinebrook RX Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

031942 Issued in NY

Legal business name

PINEBROOK RX INC

Practice address

1183 Jerome Ave
Bronx, NY 10452-3331

Phone

(718) 992-8182

Fax

(718) 992-8184

NPI assigned

Mar 27, 2013

Organization subpart

No

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

Authorized official

Name

Ravikumar MamidelaNPI 1396926051

Title

President

Phone

(718) 992-8182

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pinebrook Pharmacy Doing business as

Practitioners 1

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

• Ravikumar Mamidela

  • Pharmacist
  • Bronx, NY
  • NPI 1396926051
  NPD Authorized official

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

{
    "created_epoch": "1364342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1851634950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1183 JEROME AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104523331",
            "telephone_number": "718-992-8182",
            "fax_number": "718-992-8184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1183 JEROME AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104523331",
            "telephone_number": "718-992-8182",
            "fax_number": "718-992-8184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEBROOK RX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-27",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "MAMIDELA",
        "authorized_official_first_name": "RAVIKUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-992-8182"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "031942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03583382",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140759",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinebrook Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chana Pinczower
• Brandy D Pinder, LMT
• Elinor Pine
• Pinebrook Pharma Inc.
• Pinebrook Pharmacy, Inc.
• Jasmeen Pineda Khan, LMSW
• Rosanna Pineda Rivas
• Alvin Pineda
• Carmen Pineda, LMSW
• Daniel Pineda, RN

• Pharmacy in Bronx, NY
• Providers in Bronx, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.