Provider Demographics
NPI:1366860181
Name:DRUG MART II LLC
Entity Type:Organization
Organization Name:DRUG MART II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-569-4400
Mailing Address - Street 1:4873 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3134
Mailing Address - Country:US
Mailing Address - Phone:212-569-4400
Mailing Address - Fax:212-569-5400
Practice Address - Street 1:4873 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3134
Practice Address - Country:US
Practice Address - Phone:212-569-4400
Practice Address - Fax:212-569-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03912663Medicaid
NY32678OtherOFFICE OF PROFESSIONS
NY03912663Medicaid