Provider Demographics
NPI:1518385418
Name:ORGANIC PLANET DRIGGS CORP
Entity Type:Organization
Organization Name:ORGANIC PLANET DRIGGS CORP
Other - Org Name:ORGANIC PLANET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANAKIOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:347-799-2213
Mailing Address - Street 1:205 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6919
Mailing Address - Country:US
Mailing Address - Phone:347-799-2213
Mailing Address - Fax:
Practice Address - Street 1:205 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6919
Practice Address - Country:US
Practice Address - Phone:347-799-2213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0326383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144820OtherPK