Provider Demographics
NPI:1639488422
Name:DRUG STORES ONE LLC
Entity Type:Organization
Organization Name:DRUG STORES ONE LLC
Other - Org Name:THE DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIUSHBHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-773-6666
Mailing Address - Street 1:22-18 BROADWAY
Mailing Address - Street 2:SUITE #5
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:201-773-6666
Mailing Address - Fax:201-773-6667
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE # 5
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-773-6666
Practice Address - Fax:201-773-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2012-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X, 3336S0011X
MDP055303336C0003X
NJ28RS007077003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy