Provider Demographics
NPI:1083656540
Name:DJ DRUG CORP.
Entity Type:Organization
Organization Name:DJ DRUG CORP.
Other - Org Name:FOREST HILLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-6555
Mailing Address - Street 1:6365 108TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1604
Mailing Address - Country:US
Mailing Address - Phone:718-275-6555
Mailing Address - Fax:718-228-8815
Practice Address - Street 1:6365 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1604
Practice Address - Country:US
Practice Address - Phone:718-275-6555
Practice Address - Fax:718-228-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0251593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066958OtherPK
NY02182378Medicaid
2066958OtherPK