Provider Demographics
NPI:1376679779
Name:EXPRESS DRUGS INC
Entity Type:Organization
Organization Name:EXPRESS DRUGS INC
Other - Org Name:EXPRESS DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEBOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-569-0400
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-0391
Mailing Address - Country:US
Mailing Address - Phone:212-569-0400
Mailing Address - Fax:212-569-5280
Practice Address - Street 1:126 DYCKMAN ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1001
Practice Address - Country:US
Practice Address - Phone:212-569-0400
Practice Address - Fax:212-569-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0213973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01373293Medicaid
3325568OtherNCPDP PROVIDER IDENTIFICATION NUMBER