1265537807 NPI number — THRIFTWAY FAR ROCKAWAY DRUG CORP

Table of content: (NPI 1265537807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265537807 NPI number — THRIFTWAY FAR ROCKAWAY DRUG CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIFTWAY FAR ROCKAWAY DRUG CORP
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:
Provider Other Organization Name Type Code:
6
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:
1265537807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2102 MOTT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAR ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11691-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-327-2559
Provider Business Mailing Address Fax Number:
718-327-2491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 MOTT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-327-2559
Provider Business Practice Location Address Fax Number:
718-327-2491
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEARLMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
212-737-5560

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  011557 , 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: 3317220 . This is a "NCPDP ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00261532 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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