Provider Demographics
NPI:1609194182
Name:TOTALCARE PHARMACY MANAGEMENT INC
Entity type:Organization
Organization Name:TOTALCARE PHARMACY MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-584-6561
Mailing Address - Street 1:322 E 194TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4304
Mailing Address - Country:US
Mailing Address - Phone:718-584-6561
Mailing Address - Fax:718-584-6571
Practice Address - Street 1:322 E 194TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4304
Practice Address - Country:US
Practice Address - Phone:718-584-6561
Practice Address - Fax:718-584-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301233336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125076OtherPK
NY3233947Medicaid