Provider Demographics
NPI:1639180284
Name:R AND M DRUG CORP
Entity Type:Organization
Organization Name:R AND M DRUG CORP
Other - Org Name:VITALITY DRUG & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:PRAJESH
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-343-0070
Mailing Address - Street 1:25921 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1248
Mailing Address - Country:US
Mailing Address - Phone:718-343-0070
Mailing Address - Fax:718-343-0096
Practice Address - Street 1:25921 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1248
Practice Address - Country:US
Practice Address - Phone:718-343-0070
Practice Address - Fax:718-343-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336C0004X
NY0261543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059483OtherPK
NY02405012Medicaid
NY02405012Medicaid