Provider Demographics
NPI:1518962786
Name:KINGS-THRIFTWAY DRUGS, INC.
Entity Type:Organization
Organization Name:KINGS-THRIFTWAY DRUGS, INC.
Other - Org Name:THRIFTWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
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 1:1909 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1313
Mailing Address - Country:US
Mailing Address - Phone:718-339-3500
Mailing Address - Fax:718-998-2280
Practice Address - Street 1:1909 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1313
Practice Address - Country:US
Practice Address - Phone:718-339-3500
Practice Address - Fax:718-998-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021244333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01288655Medicaid
NY1276800001Medicare NSC