Provider Demographics
NPI:1043245517
Name:MEADOW PARK DRUG INC.
Entity Type:Organization
Organization Name:MEADOW PARK DRUG INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-699-7171
Mailing Address - Street 1:10807 CORONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3941
Mailing Address - Country:US
Mailing Address - Phone:718-699-7171
Mailing Address - Fax:718-699-7554
Practice Address - Street 1:10807 CORONA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3941
Practice Address - Country:US
Practice Address - Phone:718-699-7171
Practice Address - Fax:718-699-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01339651Medicaid
NY1101560001Medicare ID - Type Unspecified