Provider Demographics
NPI:1689691347
Name:DRUG MART CORP
Entity Type:Organization
Organization Name:DRUG MART CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:TEHFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-824-3745
Mailing Address - Street 1:1959 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4505
Mailing Address - Country:US
Mailing Address - Phone:718-824-3745
Mailing Address - Fax:
Practice Address - Street 1:1959 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4505
Practice Address - Country:US
Practice Address - Phone:718-824-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3351727OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY1689691347Medicare UPIN
NY5729540001Medicare NSC