Provider Demographics
NPI:1821531898
Name:SINA DRUG LLC
Entity Type:Organization
Organization Name:SINA DRUG LLC
Other - Org Name:ONCO360
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKENRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-662-6633
Mailing Address - Street 1:13410 EASTPOINT CENTRE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4160
Mailing Address - Country:US
Mailing Address - Phone:877-662-6633
Mailing Address - Fax:877-662-6355
Practice Address - Street 1:1985 MARCUS AVE STE 120
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2024
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:877-662-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NY252893336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02317393Medicaid
NY25289OtherPHARMACY PERMIT
NY25289OtherPHARMACY PERMIT