Provider Demographics
NPI:1417039207
Name:B EIDINGER & SON DRUG CORP
Entity Type:Organization
Organization Name:B EIDINGER & SON DRUG CORP
Other - Org Name:ELLIOTT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-475-1144
Mailing Address - Street 1:250 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7465
Mailing Address - Country:US
Mailing Address - Phone:212-475-1144
Mailing Address - Fax:212-777-1032
Practice Address - Street 1:250 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7465
Practice Address - Country:US
Practice Address - Phone:212-475-1144
Practice Address - Fax:212-777-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0065993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3376907OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY00935680Medicaid