Provider Demographics
NPI:1730291741
Name:DVN DRUG CORP
Entity Type:Organization
Organization Name:DVN DRUG CORP
Other - Org Name:MAPLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-265-4040
Mailing Address - Street 1:304 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4913
Mailing Address - Country:US
Mailing Address - Phone:631-265-4040
Mailing Address - Fax:631-265-4071
Practice Address - Street 1:304 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4913
Practice Address - Country:US
Practice Address - Phone:631-265-4040
Practice Address - Fax:631-265-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0221743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066180OtherPK
NY01492382Medicaid
0960510001Medicare NSC