Provider Demographics
NPI:1790052553
Name:DPR EQUITY INC
Entity Type:Organization
Organization Name:DPR EQUITY INC
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-292-8200
Mailing Address - Street 1:1987 STATE ROUTE 52
Mailing Address - Street 2:STE 3
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-8316
Mailing Address - Country:US
Mailing Address - Phone:845-292-8200
Mailing Address - Fax:845-292-9083
Practice Address - Street 1:1987 STATE ROUTE 52
Practice Address - Street 2:STE 3
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-8316
Practice Address - Country:US
Practice Address - Phone:845-292-8200
Practice Address - Fax:845-292-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0310903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133701OtherPK