Provider Demographics
NPI:1164959821
Name:CSE DRUG CORP
Entity Type:Organization
Organization Name:CSE DRUG CORP
Other - Org Name:SANTIAGO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-254-9946
Mailing Address - Street 1:4043 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2121
Mailing Address - Country:US
Mailing Address - Phone:718-205-7900
Mailing Address - Fax:718-205-7908
Practice Address - Street 1:4043 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2121
Practice Address - Country:US
Practice Address - Phone:718-205-7900
Practice Address - Fax:718-205-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0354353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05006551Medicaid