Provider Demographics
NPI:1295017994
Name:MYRTLE DRUGS INC
Entity Type:Organization
Organization Name:MYRTLE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:347-419-6737
Mailing Address - Street 1:5518 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3551
Mailing Address - Country:US
Mailing Address - Phone:718-366-6171
Mailing Address - Fax:718-366-6082
Practice Address - Street 1:5518 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3551
Practice Address - Country:US
Practice Address - Phone:718-366-6171
Practice Address - Fax:718-366-6082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17 030898333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6594700001Medicare NSC