Provider Demographics
NPI:1497089528
Name:BARDONIA DRUG INC
Entity Type:Organization
Organization Name:BARDONIA DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOUSHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-623-8200
Mailing Address - Street 1:4 BARDONIA MALL
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1647
Mailing Address - Country:US
Mailing Address - Phone:845-623-8200
Mailing Address - Fax:845-623-4148
Practice Address - Street 1:4 BARDONIA MALL
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1647
Practice Address - Country:US
Practice Address - Phone:845-623-8200
Practice Address - Fax:845-623-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0198123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01099605Medicaid
NY01099605Medicaid
NY1112700001Medicare PIN