Provider Demographics
NPI:1003254194
Name:PRIME DRUGS CORP.
Entity Type:Organization
Organization Name:PRIME DRUGS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUIRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVYDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-749-5021
Mailing Address - Street 1:22417A UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3631
Mailing Address - Country:US
Mailing Address - Phone:718-749-5021
Mailing Address - Fax:
Practice Address - Street 1:22417A UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3631
Practice Address - Country:US
Practice Address - Phone:718-749-5021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0314073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy