Provider Demographics
NPI:1558304832
Name:MEDI HEALTH DRUGS LLC
Entity Type:Organization
Organization Name:MEDI HEALTH DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-9755
Mailing Address - Street 1:4034 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6044
Mailing Address - Country:US
Mailing Address - Phone:718-321-9755
Mailing Address - Fax:718-321-9757
Practice Address - Street 1:40-34 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-321-9755
Practice Address - Fax:718-321-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027354333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672622Medicaid
NY3345988OtherNABP/NCPDP
3345988OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3345988OtherOTHER ID NUMBER-COMMERCIAL NUMBER