Provider Demographics
NPI:1730487588
Name:DRUGDEX PHARMACY
Entity Type:Organization
Organization Name:DRUGDEX PHARMACY
Other - Org Name:DANNY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:212-365-0366
Mailing Address - Street 1:1632 BRUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4553
Mailing Address - Country:US
Mailing Address - Phone:718-328-6777
Mailing Address - Fax:
Practice Address - Street 1:1632 BRUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4553
Practice Address - Country:US
Practice Address - Phone:212-365-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03332285Medicaid
6526960001Medicare NSC