Provider Demographics
NPI:1093724353
Name:DRUG MART MILLWOOD INC
Entity Type:Organization
Organization Name:DRUG MART MILLWOOD INC
Other - Org Name:DRUG MART OF MILLWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-923-9200
Mailing Address - Street 1:230 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1139
Mailing Address - Country:US
Mailing Address - Phone:914-923-9200
Mailing Address - Fax:914-923-1111
Practice Address - Street 1:230 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1139
Practice Address - Country:US
Practice Address - Phone:914-923-9200
Practice Address - Fax:914-923-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01572563Medicaid
NY1286140001Medicare NSC