Provider Demographics
NPI:1598301095
Name:SAFETY DRUGS OF BENSONHURST INC
Entity Type:Organization
Organization Name:SAFETY DRUGS OF BENSONHURST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRATOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-881-8532
Mailing Address - Street 1:6404 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3729
Mailing Address - Country:US
Mailing Address - Phone:718-236-5705
Mailing Address - Fax:718-234-0961
Practice Address - Street 1:6404 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3729
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782930Medicaid