Provider Demographics
NPI:1508861758
Name:VANDERVEER PHARMACY INC.
Entity Type:Organization
Organization Name:VANDERVEER PHARMACY INC.
Other - Org Name:THRIFTWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECTRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:PERCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-835-2000
Mailing Address - Street 1:1887 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7917
Mailing Address - Country:US
Mailing Address - Phone:718-282-2927
Mailing Address - Fax:718-284-2284
Practice Address - Street 1:1887 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7917
Practice Address - Country:US
Practice Address - Phone:718-282-2927
Practice Address - Fax:718-284-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007680333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01595880Medicaid
NY1286360001Medicare ID - Type Unspecified