Provider Demographics
NPI:1689690703
Name:DUANE READE
Entity Type:Organization
Organization Name:DUANE READE
Other - Org Name:DUANE READE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-5227
Mailing Address - Street 1:PO BOX 2253
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10116-2253
Mailing Address - Country:US
Mailing Address - Phone:212-356-5227
Mailing Address - Fax:212-244-6499
Practice Address - Street 1:3612 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-332-5887
Practice Address - Fax:718-332-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023744333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02051949Medicaid
3343489OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02051949Medicaid