Provider Demographics
NPI:1336293786
Name:MADISON CHEMIST INC
Entity Type:Organization
Organization Name:MADISON CHEMIST INC
Other - Org Name:DRUG LOFT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-996-9499
Mailing Address - Street 1:1408 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6947
Mailing Address - Country:US
Mailing Address - Phone:212-996-9499
Mailing Address - Fax:212-876-7782
Practice Address - Street 1:1408 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6947
Practice Address - Country:US
Practice Address - Phone:212-996-9499
Practice Address - Fax:212-876-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0204663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1495936Medicaid
2066575OtherPK