Provider Demographics
NPI:1194860296
Name:CORAM DRUGS INC.
Entity Type:Organization
Organization Name:CORAM DRUGS INC.
Other - Org Name:YORE-X DRUGS AND SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAYYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-698-7788
Mailing Address - Street 1:1850 ROUTE 112 STE P
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2232
Mailing Address - Country:US
Mailing Address - Phone:631-698-7788
Mailing Address - Fax:631-698-0103
Practice Address - Street 1:1850 ROUTE 112 STE P
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2232
Practice Address - Country:US
Practice Address - Phone:631-698-7788
Practice Address - Fax:631-698-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023236332B00000X, 332BN1400X, 332BP3500X, 332BX2000X, 333600000X, 3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742121Medicaid
NY1262840001Medicare NSC
NY1262840001Medicare ID - Type Unspecified