Provider Demographics
NPI:1346322138
Name:MARLBORO DRUG CO INC
Entity Type:Organization
Organization Name:MARLBORO DRUG CO INC
Other - Org Name:MARLBORO DRUG CO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZIONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-373-2600
Mailing Address - Street 1:2313 STILLWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5647
Mailing Address - Country:US
Mailing Address - Phone:718-373-2600
Mailing Address - Fax:718-266-5044
Practice Address - Street 1:2313 STILLWELL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5647
Practice Address - Country:US
Practice Address - Phone:718-373-2600
Practice Address - Fax:718-266-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0074063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00263841Medicaid
3325746OtherNCPDP PROVIDER IDENTIFICATION NUMBER