1942221908 NPI number — 5247 BROADWAY DRUGS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942221908 NPI number — 5247 BROADWAY DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
5247 BROADWAY DRUGS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRUG MART
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942221908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5203A BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10463-7636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-562-6637
Provider Business Mailing Address Fax Number:
718-562-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5203A BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463-7636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-562-6637
Provider Business Practice Location Address Fax Number:
718-562-5031
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARVALIA
Authorized Official First Name:
ASHOK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT,AO
Authorized Official Telephone Number:
718-562-6637

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 022921 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2060694 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01639367 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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