Provider Demographics
NPI:1568477164
Name:DOUBLE G PHARMACEUTICALS,INC.
Entity Type:Organization
Organization Name:DOUBLE G PHARMACEUTICALS,INC.
Other - Org Name:DOUBLE G PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING RPH
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-728-3127
Mailing Address - Street 1:2282 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2714
Mailing Address - Country:US
Mailing Address - Phone:718-728-3127
Mailing Address - Fax:718-728-1623
Practice Address - Street 1:2282 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2714
Practice Address - Country:US
Practice Address - Phone:718-728-3127
Practice Address - Fax:718-728-1623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0209113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3398282OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01503837Medicaid