Provider Demographics
NPI:1417962051
Name:DRUG RITE II PHARMACY CORP
Entity Type:Organization
Organization Name:DRUG RITE II PHARMACY CORP
Other - Org Name:DRUG RITE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-231-1600
Mailing Address - Street 1:3432 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1002
Mailing Address - Country:US
Mailing Address - Phone:718-231-1600
Mailing Address - Fax:718-231-1606
Practice Address - Street 1:3432 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1002
Practice Address - Country:US
Practice Address - Phone:718-231-1600
Practice Address - Fax:718-231-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0268923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595637Medicaid
3340572OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5290420001Medicare NSC