Provider Demographics
NPI:1013000793
Name:DANAR TWO INC
Entity Type:Organization
Organization Name:DANAR TWO INC
Other - Org Name:MEMORIAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:S.P PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADALOV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-567-2661
Mailing Address - Street 1:699 92ND STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:718-567-2661
Mailing Address - Fax:718-567-2667
Practice Address - Street 1:699 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-567-2661
Practice Address - Fax:718-567-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109231Medicaid
NY02109231Medicaid