Provider Demographics
NPI:1821063504
Name:666 DRUG INC
Entity Type:Organization
Organization Name:666 DRUG INC
Other - Org Name:MELROSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DETURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-1856
Mailing Address - Street 1:666 COURTLANDT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5018
Mailing Address - Country:US
Mailing Address - Phone:718-292-1856
Mailing Address - Fax:718-665-2123
Practice Address - Street 1:666 COURTLANDT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5018
Practice Address - Country:US
Practice Address - Phone:718-292-1856
Practice Address - Fax:718-665-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017367333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129033Medicaid