Provider Demographics
NPI:1093051757
Name:NOLITA DRUG CORPORATION
Entity Type:Organization
Organization Name:NOLITA DRUG CORPORATION
Other - Org Name:NOLITA CHEMISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:917-887-1059
Mailing Address - Street 1:208 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4102
Mailing Address - Country:US
Mailing Address - Phone:212-226-1415
Mailing Address - Fax:212-226-1701
Practice Address - Street 1:208 MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4102
Practice Address - Country:US
Practice Address - Phone:212-226-1415
Practice Address - Fax:212-226-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0319243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140162OtherPK
NY3533608Medicaid
NY3533608Medicaid