Provider Demographics
NPI:1356493456
Name:MEDICITI DRUGS INC
Entity Type:Organization
Organization Name:MEDICITI DRUGS INC
Other - Org Name:RIDGEWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SADATH
Authorized Official - Middle Name:ULLA
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-381-3622
Mailing Address - Street 1:389 ONDERDONK AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1336
Mailing Address - Country:US
Mailing Address - Phone:718-381-3622
Mailing Address - Fax:718-381-7992
Practice Address - Street 1:389 ONDERDONK AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1336
Practice Address - Country:US
Practice Address - Phone:718-381-3622
Practice Address - Fax:718-381-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025558333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02383755Medicaid
NY02383755Medicaid