Provider Demographics
NPI:1326053778
Name:BOAN DRUGS INC
Entity Type:Organization
Organization Name:BOAN DRUGS INC
Other - Org Name:EMBASSY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASERES
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:212-690-1331
Mailing Address - Street 1:1842 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1703
Mailing Address - Country:US
Mailing Address - Phone:212-690-1331
Mailing Address - Fax:212-283-6720
Practice Address - Street 1:1842 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-1703
Practice Address - Country:US
Practice Address - Phone:212-690-1331
Practice Address - Fax:212-283-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0145623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014652OtherNYS DEPT. OF EDUCATION
NY01463143Medicaid
NY3315288OtherNABP NO