Provider Demographics
NPI:1679688857
Name:MIDLAND PHARMACY AND HEALTHCARE PRODUCTS INC
Entity Type:Organization
Organization Name:MIDLAND PHARMACY AND HEALTHCARE PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMICIST
Authorized Official - Prefix:
Authorized Official - First Name:GENNARO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLA RAGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-351-1689
Mailing Address - Street 1:606 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5926
Mailing Address - Country:US
Mailing Address - Phone:718-351-1689
Mailing Address - Fax:
Practice Address - Street 1:606 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5926
Practice Address - Country:US
Practice Address - Phone:718-351-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0223783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01548205Medicaid