Provider Demographics
NPI:1598990004
Name:DDMH PHARMACY INC
Entity Type:Organization
Organization Name:DDMH PHARMACY INC
Other - Org Name:DRUG DEPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-299-9600
Mailing Address - Street 1:1588 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6994
Mailing Address - Country:US
Mailing Address - Phone:718-299-9600
Mailing Address - Fax:718-299-9602
Practice Address - Street 1:1588 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6994
Practice Address - Country:US
Practice Address - Phone:718-299-9600
Practice Address - Fax:718-299-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0296153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3125775Medicaid
3363316OtherNCPDP PROVIDER IDENTIFICATION NUMBER