Provider Demographics
NPI:1235124009
Name:MERRICK DRUGS INC.
Entity Type:Organization
Organization Name:MERRICK DRUGS INC.
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKSUMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-379-5446
Mailing Address - Street 1:2013 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4644
Mailing Address - Country:US
Mailing Address - Phone:516-379-5446
Mailing Address - Fax:516-379-5859
Practice Address - Street 1:2013 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4644
Practice Address - Country:US
Practice Address - Phone:516-379-5446
Practice Address - Fax:516-379-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02067045Medicaid
NY3905630001Medicare ID - Type Unspecified