Provider Demographics
NPI:1508916305
Name:THE DRUG SHOPPE, INC.
Entity Type:Organization
Organization Name:THE DRUG SHOPPE, INC.
Other - Org Name:THE DRUG SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-694-3138
Mailing Address - Street 1:525 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4403
Mailing Address - Country:US
Mailing Address - Phone:716-694-3138
Mailing Address - Fax:716-694-3139
Practice Address - Street 1:525 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4403
Practice Address - Country:US
Practice Address - Phone:716-694-3138
Practice Address - Fax:716-694-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0199923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01097974Medicaid
NY3392999OtherNABP
NY3392999OtherNABP
NY0322380001Medicare ID - Type Unspecified